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5. Give the name and public safety agency or former agency of each active and retired public safety
officer who serves on the board of directors or governing body of the registering entity, if any.
6. How many members are active and retired public safety officers of the United States, this state, or a
political subdivision of this state, as determined on December 31 of the year preceding the year in
which the registration is made and for which the contributions are solicited, if the registering entity
is a public safety organization?
7. What percentage of members are active and retired public safety officers of the United States, this
state, or a political subdivision of this state, as determined on December 31 of the year preceding
the year in which the registration is made and for which the contributions are solicited, if the
registering entity is a public safety organization?
8. List the name of the local chapter, lodge, association, or group of licensed public safety officers of
the public safety organization for which contributions are to be solicited, if the registering entity is a
public safety organization.
9. Attach a copy of the most recent tax or informational return filed with the Internal Revenue Service
by the registering entity.
10. List below the amount of funds collected during the previous year by the registering entity through
solicitations of nonmembers of the public safety organization for which the funds were collected
and the amount of funds that are paid as expenses to maintain the solicitation operation.
Amount Collected:
Amount Paid as Expenses:
11. If known or projected, indicate below the amount of funds expected to be collected during the year
of filing by the registering entity through solicitations of nonmembers described by #10 above.
12. Attach a copy of any contract or agreement between the registering entity and a solicitor.
