Fund-Raising Counsel Application For Registration Form - Office Of The Attorney General Page 3
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510. Have any officers, directors, partners, managers, or supervisors ever been sued for fund-raising-related activities?
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NO
YES. If so, explain in detail and attach copies of the lawsuit, judgment, decree and/or court order for
each such occurrence: ________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
11. Have any officers, directors, partners, managers, or supervisors ever entered into, or been subject to, any assurance
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of voluntary compliance, cease and desist order, or other private settlements with any governmental authority?
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NO
YES. If so, explain in detail and attach a copy of any such document:_____________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
12. Have any officers, directors, partners, managers, or supervisors ever been charged, arrested and/or convicted of a
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crime other than a simple traffic violation?
NO
YES. If so, state the charge(s), state(s) involved and, if
convicted, attach a copy of each relevant judgment and/or court order:
___________________________________________________________________________________________
___________________________________________________________________________________________
13.
List the legal names of the charitable organizations which you will be providing counsel and the time frame of
service:
___________________________________________________________________________
___________________________________________________________________________
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14.
Is the registrant a corporation or other entity (not an individual)?
NO
YES If so, provide the following
information:
__________________________________________________________________________________________
a. Name of corporation/entity
_________________________________________________________________________________________
b. State in which registrant is incorporated and/or organized
__________________________________________________________________________________________
c. Address - principal place of business
d. Telephone number - principal place of business (include area code)
15.
State the names, addresses, and telephone numbers of all persons (including individuals, organizations, trusts,
foundations, associations, partnerships, and/or corporations) who own a ten percent (10%) or greater interest in the
registrant: (Attach additional sheets if necessary.)
________________________________
_______________________________
(a)
(b)
Name
Name
______________________________________
______________________________________
Address
Address
______________________________________
______________________________________
Telephone Number
Telephone Number
(c)
_____________________________________
(d) _____________________________________
Name
Name
_____________________________________
_____________________________________
Address
Address
_____________________________________
_____________________________________
Telephone Number
Telephone Number
16. Provide a detailed description of any other business related to fund-raising conducted by the registrant or any
person who owns ten percent (10%) or more interest:
_______________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
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