Form Sr-2 - Campaign Report Of Charitable Solicitation By An Independent Paid Fund Raiser Or Fund-Raising Counsel - New Jersey Office Of The Attorney General
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2New Jersey Office of the Attorney General
Division of Consumer Affairs
Office of Consumer Protection
Charities Registration Section
124 Halsey Street, 7
Floor, P.O. Box 45021
th
Newark, NJ 07101
(973) 504-6215
Form SR-2
(As Revised April 2016)
(Previous versions of this form may no longer be used and will not be accepted.)
Campaign Report of Charitable Solicitation
by an Independent Paid Fund Raiser or Fund-Raising Counsel
(Without custody, control, possession or access to the charitable organization’s contributions)
All of the questions must be answered.
This form must be signed by the officers of both the charity and the independent paid fund raiser or fund-raising counsel.
1. Name of Independent Paid Fund Raiser or Fund-Raising Counsel:
________________________________________________________________________________________________________
N.J. Registration Number: PFR-_________-00 Phone Number: (_____)_________ Please check if the address has changed
Mailing Address: _________________________________________________________________________________________
Address
City
State
ZIP code
Street Address: ___________________________________________________________________________________________
Street Address
City
State
ZIP code
2. Name of Charitable Organization: __________________________________________________________________________
N.J. Charities Registration Number: CH-_________-00 Phone Number: (_____)_____________ Please check if the address
has changed
Mailing Address: __________________________________________________________________________________________
Address
City
State
ZIP code
Street Address: ___________________________________________________________________________________________
Street Address
City
State
ZIP code
3. Dates of Solicitation: From: __ __ /__ __ /__ __ To: __ __ /__ __ /__ __ Type of Event:_____________________________
Is this a final report?
Yes
No If “Yes,” enter the date the solicitation ended (mm/dd/yyyy): _____________________
4. Method of Solicitation (check all that apply):
Phone
Direct
Mail
In-Person/Door to Door
Internet
Text Message
TV
Radio
Newspaper/Magazine
Other (specify)
________________________________________________________________________________________________________
Purpose of Solicitation: ____________________________________________________________________________________
5. Gross Revenue taken in by the charitable campaign:
$ _______________________________________
6. Net amount retained by the charitable organization:
$ _______________________________________
7. Independent paid fund raiser or fund-raising counsel compensation:
$ _______________________________________
8. Basis of compensation - i.e. percentage, flat fee, combo:
_______________________________________
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