Part F - Organization Structure
1. Incorporation / formation
a. Type of organization:
b. Type of corporation if New York not-for-profit corporation
G
Corporation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
G
G
G
A
B
C
D
G
Limited liability company (LLC) . . . . . . . . . . . . . . . . . . . . . . . . .
G
Partnership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
c. Date incorporated if a corporation or formed if other than a corporation
G
Sole proprietorship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
__ __ / __ __ / __ __ __ __
G
Trust . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
G
Unincorporated association . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. State in which incorporated or formed
G
* Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
* If Other, describe:
2. List all chapters, branches and affiliates of your organization (attach additional sheets if necessary)
Mailing address (number and street, room/suite,
Name
Relationship
City or town, state or country and zip+4)
3. List all officers, directors, trustees and key employees
Mailing address (number and street, room/suite,
End of term
Name
Title
city or town, state or country and zip+4)
(if applicable)
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
_ _ / _ _ / _ _ _ _
4. Other Names and Registration Numbers
a. List all other names used by your organization, including any prior names
b. List all prior New York State charities registration numbers for the organization, including those from the New York State Attorney General’s
Charities Bureau or the New York State Department of State’s Office of Charities Registration
Page 2 of 3
Form CHAR410-R (2010)