Form PFR-5 "Solicitation Notice" - New Hampshire

What Is Form PFR-5?

This is a legal form that was released by the New Hampshire Department of Justice - a government authority operating within New Hampshire. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2003;
  • The latest edition provided by the New Hampshire Department of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form PFR-5 by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Justice.

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Download Form PFR-5 "Solicitation Notice" - New Hampshire

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STATE OF NEW HAMPSHIRE
*
DEPARTMENT OF JUSTICE
*
OFFICE OF THE ATTORNEY GENERAL
*
CHARITABLE TRUSTS UNIT
*
SOLICITATION NOTICE
This Solicitation Notice and $200.00 fee must be filed with the Department of Justice, Office of the
Attorney General, Charitable Trusts Unit, prior to the start of each solicitation campaign. The
solicitation campaign may begin no earlier than the eleventh business day after receipt in the
Charitable Trusts Unit of this solicitation notice. ANSWER ALL QUESTIONS; LEAVE NO
BLANKS. Mail or deliver the completed Solicitation Notice and attachments to: Department of
Justice, Office of the Attorney General, Charitable Trusts Unit, 33 Capitol Street, Concord, N.H.
03301-6397. Make the check payable to State of New Hampshire.
___________________________________________________
Do you have a Certificate of Registration as a paid solicitor from the Attorney General, Charitable
Trusts Unit, in full force and effect?
Yes_______
Registration #___________
No___________
If no, you must complete an Application for Registration (PFR #4) prior to the submission of this
Solicitation Notice.
1.
Name and address of paid solicitor:
*
2. Name and address of organization
*
on whose behalf the solicitation will
*
be conducted:
____________________________________ *
_________________________________
____________________________________ *
_________________________________
____________________________________ *
_________________________________
_______ Check here if organization is a police, law enforcement or firefighters association (see
attachment entitled “Solicitations by Police, Law Enforcement and Firefighters
Associations”)
3. Date soliciting begins: ______________
*
4. Date soliciting ends: ___________
5. Soliciting will be conducted by: (check all that apply) telephone _______ mail _______
electronic media (TV, radio, on-line computer) ________ print media (newspapers,
magazines) ________ other (describe):________________________________________
6. If persons soliciting will be contacted by both telephone and mail, how will the initial contact
be made?
telephone___________
mail_____________
STATE OF NEW HAMPSHIRE
*
DEPARTMENT OF JUSTICE
*
OFFICE OF THE ATTORNEY GENERAL
*
CHARITABLE TRUSTS UNIT
*
SOLICITATION NOTICE
This Solicitation Notice and $200.00 fee must be filed with the Department of Justice, Office of the
Attorney General, Charitable Trusts Unit, prior to the start of each solicitation campaign. The
solicitation campaign may begin no earlier than the eleventh business day after receipt in the
Charitable Trusts Unit of this solicitation notice. ANSWER ALL QUESTIONS; LEAVE NO
BLANKS. Mail or deliver the completed Solicitation Notice and attachments to: Department of
Justice, Office of the Attorney General, Charitable Trusts Unit, 33 Capitol Street, Concord, N.H.
03301-6397. Make the check payable to State of New Hampshire.
___________________________________________________
Do you have a Certificate of Registration as a paid solicitor from the Attorney General, Charitable
Trusts Unit, in full force and effect?
Yes_______
Registration #___________
No___________
If no, you must complete an Application for Registration (PFR #4) prior to the submission of this
Solicitation Notice.
1.
Name and address of paid solicitor:
*
2. Name and address of organization
*
on whose behalf the solicitation will
*
be conducted:
____________________________________ *
_________________________________
____________________________________ *
_________________________________
____________________________________ *
_________________________________
_______ Check here if organization is a police, law enforcement or firefighters association (see
attachment entitled “Solicitations by Police, Law Enforcement and Firefighters
Associations”)
3. Date soliciting begins: ______________
*
4. Date soliciting ends: ___________
5. Soliciting will be conducted by: (check all that apply) telephone _______ mail _______
electronic media (TV, radio, on-line computer) ________ print media (newspapers,
magazines) ________ other (describe):________________________________________
6. If persons soliciting will be contacted by both telephone and mail, how will the initial contact
be made?
telephone___________
mail_____________
- 2 -
7. If soliciting will be conducted by telephone, state the address and telephone number for each
location from which calls will be made, and the name and residence address of the office
manager or other person in charge at each location. (If more than two locations, continue on a
separate sheet.)
(a) _________________________
* (b) __________________________
_________________________
*
__________________________
street
street
________________________
*
___________________________
city
state
zip
city
state
zip
telephone (___)___________
*
telephone (___)______________
Manager: ________________________
* Manager: ______________________
residence address:
residence address:
_________________________
* _______________________________
_________________________
* _______________________________
8. Will the solicitation campaign include the sale of goods or services? Yes _____ No_____
If yes, check one or more of the following that apply:
_______tickets to an event or performance
_______advertising space in a program book, journal or other publication
_______ other (describe:___________________________________________________)
9. If tickets to an event or performance will be sold, state:
date of event:____________ nature of event: ___________________________________
location of event (street/city/state):____________________________________________
If tickets are to be donated for use by another, please state the names and addresses of the
charitable organizations which have agreed to accept the donated tickets:_____________
________________________________________________________________________
10. State the account number and location of each bank account where the paid solicitor will
deposit contributions in its’ custody. (If more than two accounts, continue on a separate sheet).
IF PAID SOLICITOR DOES NOT HAVE CUSTODY AND CONTROL OF THESE
- 3 -
FUNDS, THE CONTRACT SHALL SPECIFICALLY STATE THAT THE CHARITABLE
ORGANIZATION WILL HAVE SOLE CUSTODY AND CONTROL OF ALL DONATIONS
RECEIVED.
(a) account number:__________________ * (b) account number:_________________
bank name:_____________________ *
bank name:_____________________
bank address:___________________ *
bank address:___________________
___________________ *
___________________
Name and address of person(s) authorized to withdraw from account(s):
_____________________________
*
______________________________
_____________________________
*
______________________________
11. List the names and residence addresses of all individuals who will solicit during the campaign.
If more space is needed please continue on a separate sheet. As additional employees are
added, please complete and submit form PFR-5A.
Names
Addresses
_____________________________________
__________________________________
_____________________________________
__________________________________
_____________________________________
__________________________________
_____________________________________
__________________________________
12. Have any of the persons listed in response to #7 or #11 been convicted by a court of any state
or the United States of any felony, or of any misdemeanor involving dishonesty or arising from
the conduct of a solicitation for a charitable organization or purpose?
Yes_________
No__________
If yes, attach a detailed explanation.
13. Describe fully the charitable program for which the solicitation campaign is being carried out.
If solicitation will be through the distribution (including mailing) of printed material, attach a
sample of each piece.
14. If solicitation will be made orally, attach a summary of the language to be used describing the
charitable program as well as the method by which disclosure of the paid solicitor’s status as a
fundraiser will be made.
15. A copy of the contract between the paid solicitor and the charitable organization, police, law
enforcement, or firefighters association (or a Notice of Contract on forms prescribed by the
Attorney General) must accompany this Solicitation Notice.
- 4 -
16. Are any of the directors or principal officers of the paid solicitor a director or principal
employee of the organization for which the solicitation is being conducted?
Yes________
No___________
If yes, please attach an explanation.
Any changes to the information provided in this Solicitation Notice must be reported to the
Department of Justice, Office of the Attorney General, Charitable Trusts Unit, in writing
signed by both the paid solicitor and the charity within seven (7) days of the change.
_______________________________________
_____________________
__________
Signature of paid solicitor officer
Title
Date
STATE OF
COUNTY OF
Before me personally appeared _____________________________, the signer of the foregoing
Solicitation Notice, who has acknowledged him/herself as such officer of the said organization,
and as such officer being authorized to do so, has read the foregoing application, and has before me
deposed and said that the above statements, and all attachments, are true and correct to the best of
his/her knowledge and belief.
___________________________________(seal)
Date:___________________
Notary Public
My commission expires:_______________
CERTIFICATION OF CHARITABLE ORGANIZATION, POLICE, LAW ENFORCEMENT,
OR FIREFIGHTERS ASSOCIATION
I,____________________________________, ____________________________, of
(print name)
(title)
__________________________________________, under penalty of false statement, (name of
organization/association) hereby certify that I am authorized to sign this certification and that the
statements made in the foregoing application and all attachments, including samples of printed
solicitation material and the text or script of any oral solicitation, are true and accurate to the best
of my knowledge and belief.
Signed:______________________________________ Date:_______________________
Title:
PFR-5 (4889-1.doc) (7/1/03)
SOLICITATIONS BY POLICE, LAW ENFORCEMENT AND
FIREFIGHTERS ASSOCIATIONS
Amendments to the charitable solicitations law effective July 1, 1992 require
paid solicitors to file solicitation notices and comply with the other provisions of
RSA 7:28-c when they conduct fundraising campaigns on behalf of “a police, law
enforcement or firefighters association.” The fundraising campaigns affected by
the amendment are those conducted by a professional fundraiser for police, law
enforcement and firefighting personnel whose purposes are not exclusively or
primarily charitable.
The amendments do not:
(1) Require any non-profit organization to register with the Attorney General
after July 1, 1992 if it was not required to register prior to that date as a charitable
trust.
(2) Impose any special requirements on professional fundraisers for police,
law enforcement and firefighters groups.
(3) Impose any special conditions on police, law enforcement or firefighters
solicitations.