501(C)3 Verification Form printable pdf download

501(C)3 Verification Form

501(c)3 VERIFICATION REQUIRED

Please verify your 501(c)3 status as a charitable organization, which is a requirement for

participation in Birdies for Charity. Attached please find a charitable organization form which

should be signed and returned before you may participate. Your official IRS 501(c)3 form is

not needed at this time, we just need verification that 501(c)3 status is still current for your

organization. This form must be signed for checks to be written to your organization. Money

collected by Birdies for Charity for organizations without 501(c)3 verification will be applied to

the Birdies for Charity Fund to benefit ALL participating, qualified 501(c)3 organizations.

Charity Name:____________________________________________________________

Bird #:__________________________________________________________________

Charitable Organization 501(c)3 Verification

This form certifies that (Charity name)___________________________________________

is still a valid 501(c)3 charitable organization as reflected in the original submission to the

Birdies for Charity program. It also certifies that the charity agrees to comply with the rules

and regulations of the Birdies for Charity program as stated in the official program rules. The

Birdies for Charity program is intended to support charitable organizations, services, operations,

and programs. It is not intended to be used for endowment or brick and mortar charitable

purposes. Charitable contributions may not be part of a capital campaign and must come from a

designated donor.

Signature and Title of person signing

Date

Updated contact information if changed from prior year:

Contact Person:___________________________________________________________

Contact Address:__________________________________________________________

(required) Email address: ___________________________________________________

Contact Phone:____________________________________________________________

Please sign and return as soon as possible to:

Birdies for Charity

Attention: Amy Finn

15623 Coaltown Road

East Moline, IL 61244

Fax: (309)762-4668

501(C)3 Verification Form