Form Cri-200 - Short-Form Registration/verification Statement printable pdf download

New Jersey Office of the Attorney General

Division of Consumer Affairs

Office of Consumer Protection

Charities Registration Section

153 Halsey Street, 7

Floor, P.O. Box 45021

Newark, NJ 07101

(973) 504-6215

Form CRI-200

Short-Form Registration/Verification Statement

(Revised April 2008)

All of the questions must be answered.

Charitable organizations, domiciled or doing business in the State of New Jersey, which receive gross contributions of $25,000 or less

per year, are required to submit an initial registration and to renew registration annually. In both circumstances this form may be used. In

the event an organization receives gross contributions of less than $10,000 per year and does not compensate anyone to solicit or perform

fund-raising activities on its behalf, the organization is exempt from registration, but may still choose to register. The registration fee for

charities with gross contributions between $0 and $25,000 is $30, whether the fee is for an initial or renewal registration. Payment is to

be made by check or money order, made payable to the “New Jersey Division of Consumer Affairs,” and is due at the time of submission

of the form.

1. This statement contains the facts and financial information for the fiscal year ending: _____/ _____/ ________

month

day

year

2. Federal ID Number (EIN) __________________ 2a. N.J. Charities Registration Number: CH- _________________________

(Leave blank ONLY if this is an initial registration.)

Full legal name of the registering organization: ______________________________________________________________

In care of: (if necessary, otherwise leave this line blank) __________________________________________________________

Mailing Address: ____________________________________________________________________ £ Change of Address

Street Address

City

State

ZIP Code

NOTE: If “ in care of,” a postal, private or rural delivery mail box number is used, the street address of the charity must be given below.

5. The principal street address of the registering organization________________________________________________________

£ Same as Mailing Address

Street Address

City

State

ZIP Code

Does the organization have any offices in New Jersey in addition to the one listed above?

£ Yes £ No

If “Yes,” attach a list giving the street address and telephone number of each office in New Jersey.

6a. If the street address listed above is not where the organization’s official records are kept, or if the organization does not maintain an

office in New Jersey, indicate the name, full address, phone and fax number of the person having custody of the organization’s records,

and to whom correspondence should be addressed.

_______________________________________________________________________________________________________

Contact person

Street address

City

State

ZIP Code

________________________________ ________________________________

Telephone number (include area code)

Fax number (include area code)

Organization’s contact information:

________________________________ ________________________________

Telephone number (include area code)

Fax number (include area code)

________________________________ ________________________________

E-mail address

Web site

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Form Cri-200 - Short-Form Registration/verification Statement

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