Charitable Organization Permit Renew Utah 2015-2026

Updated April 2015 See Instructions for Charitable Organization Permit Application Form. PART I APPLICANT S IDENTIFICATION 2. State of Utah DEPARTMENT OF COMMERCE DIVISION OF CONSUMER PROTECTION CHARITABLE ORGANIZATION PERMIT APPLICATION FORM OFFICE USE ONLY Date Issued Annual Application fee 75. 00 Non-refundable Permit Number Approved Name of Charitable Organization Exempt Denied Date of Application Expiration Percentage of total contributions that are available for the charitable purpose Please mark the appropriate box INITIAL APPLICATION RENEWAL If you have any further questions please contact the Division at 801 530-6601. Please make application fee check or money order payable to the State of Utah. Please return the completed application form and check or money order to Department of Commerce Division of Consumer Protection 160 East 300 South Box 146704 Salt Lake City Utah 84114-6704 NOTE The Charitable Solicitation permit will expire annually on the earlier of January 1 April 1 July 1 or October 1 following the completion of 12 months after the date of initial issuance. If this is an initial application or a renewal application of an organization which has let its permit expire has the applicant conducted activities regulated by the Charitable Solicitations Act Utah Code Title 13 Chapter 22 without being duly registered with the Division This includes soliciting requesting promoting advertising or sponsoring a charitable solicitation in the state of Utah without being duly registered with the Division. 2. If yes please attach a schedule to explain in detail including how much was collected who actually coordinated and scheduled the solicitation s the dates of the solicitation s and the number of pieces mailed and/or the number of solicitations made for each date indicated. PART XI SIGNATURE / ACKNOWLEDGEMENT The person signing this application on behalf of the charitable organization - affirms that this application is complete and not misleading - understands that this application is subject to audit and - acknowledges that fund raising in Utah will not commence until both the charitable organization its parent foundation if any and the professional fund raiser or professional fund raising counsel or consultant are registered and in compliance with the Utah Charitable Solicitations Act. DATED SIGNATURE Printed Name/Title DOCUMENT CHECKLIST INITIAL APPLICATION Articles of incorporation or other organizational documentation showing current legal status Current by-laws or other documents showing policies and procedures governing day-to-day operations Most recent IRS Form 990 990EZ 990PF or 990N with signature If the applicant is not required to file a Form 990 or filed an IRS form 990EZ 990PF or 990N the applicant must attach a completed Statement of Functional Expenses. 00 Non-refundable Permit Number Approved Name of Charitable Organization Exempt Denied Date of Application Expiration Percentage of total contributions that are available for the charitable purpose Please mark the appropriate box INITIAL APPLICATION RENEWAL If you have any further questions please contact the Division at 801 530-6601.