Form Chr-1 - Registration Statement Of Charitable Organization
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41
WEST VIRGINIA REGISTRATION STATEMENT
OF CHARITABLE ORGANIZATION
Registration Type:
New
Renewal
Final
Date
1.
Official Name of Organization
2.
Street Address
3.
Mailing Address
4.
Phone _________________ Fax___________________ Email
5.
Principal West Virginia address
if different from above
6.
Designated contact person
Phone:
Purpose of the organization:
7.
Name, address and respon-
8.
sible person of each chapter,
branch or affiliate in the State,
if any:
9.
Are the above chapters, branches or affiliates in-
Check one:
cluded in parent organization’s registration?
Yes
No
List all names under which applicant
10.
intends to
if different from official
name, if any:
State the purposes for which the
11.
tributions will be used:
Place and date the organization was
12.
legally established:
Unincorporated
Corporation
Foundation
Association
The form of the organization (check
13.
Trust
or complete as applicable)
Other
Has the organization been determined to
14a.
Yes Type of IRS classification: 501(c)____
be tax-exempt by the Internal Revenue
Service?
No
Revised
/
Issued by the Secretary of State, State Capitol, Charleston, WV 25305
FORM CHR-1
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