Fillable N.C.G.S. 131F-3(3) Exemption Request Form NOTE: E-Postcards, 990-N (North Carolina Secretary of State)

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N.C.G.S. 131F-3(3) Exemption Request Form NOTE: E-Postcards, 990-N (North Carolina Secretary of State)

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NORTH
CAROLINA DEPARTMENT OF THE SECRETARY OF STATE
CHARITABLE SOLICITATION LICENSING DIVISION
N.C.G.S. 131F-3(3) Exemption Request Form
Telephone: 919-814-5400 – Toll Free for NC Residents: 1-888-830-4989 – Facsimile: 919-807-2220
Website Address: www.sosnc.gov – Electronic Mail: csl@sosnc.gov
Mailing Address: P O Box 29622, Raleigh, NC 27626-0622
Page 1 of 2
Revised 09/24/2020
NOTE: E-Postcards, 990-N are not accepted as proof of financial history.
1.
Charitable/Sponsor organization’s legal name:
2.
Charitable/Sponsor organization’s principal mailing address:
3.
Charitable/Sponsor organization’s principal telephone:
4.
Charitable/Sponsor organization’s e-mail address:
5.
Name(s) under which you intend to solicit contributions (if different from legal name):
6.
Purpose for which applying entity was established:
7.
Charitable/Sponsor organization’s fiscal year end month:
8.
8a.
An Officer?
YES
NO
8b.
A Trustee/Board Member?
YES
NO
8c.
An Organizer or Incorporator?
YES
NO
8d.
A Salaried Employee that occupies a seat on the board?
YES
NO
9. Does applying entity currently contract for compensation or plan to
c
ontract for compensation during the current registration year with a
Fund-Raising Consultant or Solicitor?
YE
S
NO
If applying entity answered YES to ANY part of the above questions 8 or 9, applicant does not qualify for
an exemption to the North Carolina charitable solicitation licensing requirements under N.C. Gen. Stat
.§
131F-3
(3). Applicant must either apply for a license or a separate exemption. License application form
s
a
nd a copy of the laws governing charitable solicitation are available on this Department’s website at
NORTH
CAROLINA DEPARTMENT OF THE SECRETARY OF STATE
CHARITABLE SOLICITATION LICENSING DIVISION
N.C.G.S. 131F-3(3) Exemption Request Form
Telephone: 919-814-5400 – Toll Free for NC Residents: 1-888-830-4989 – Facsimile: 919-807-2220
Website Address: www.sosnc.gov – Electronic Mail: csl@sosnc.gov
Mailing Address: P O Box 29622, Raleigh, NC 27626-0622
Page 2 of 2
Revised 09/24/2020
If applying entity received $25,000 or more in charitable contributions (as defined in N.C. Gen. Stat. § 131F-
2(5)) in the immediate preceding fiscal year, applicant will NOT qualify for an exemption to the North
Carolina charitable solicitation licensing requirements under N.C. Gen. Stat. § 131F-3(3) and must apply for a
license. License application forms and a copy of the laws governing charitable solicitation are available on this
Department’s website at www.sosnc.gov.
NOTE: 131F-2(5) Contribution is defined as including a promise, pledge, grant of any money or property, financial
assistance, or any other thing of value in response to a solicitation
.
10. Does applying entity have any financial history, (excluding a BUDGET) and received less than $25,000 i
n
c
haritable contributions (as defined in N. C. Gen. Stat. § 131F-2(5)) in the immediate preceding fiscal year?
YES
a. IRS Form 990 or 990 EZ signed by an officer of the organization. (Excluding Form 990-N)
b. An Audited Financial Statement.
c.
The NC Annual Financial Report Form (available for downloading at www.sosnc.gov).
NO
Attach a budget for the current year containing projected revenues and projected expenses.
11. Has applying entity received a Federal Tax Exemption Determination Letter?
YE
S
Attach a copy of the Federal Tax Exemption Determination Letter. (This is not required; however,
if not received the organization will be listed as a “Non-Tax Exempt Entity” as described in Section
.0305(d), Chapter 11 of Title 18 of the North Carolina Administrative Code)
NO
NOTE: This registration must be updated on an annual basis.
(Signature of an Officer of the applying organization)
(Print Name & Title)
(Completion Date)
Submit ONE of the following financial Forms, a, b or c with appropriate signatures:
Initial applicants ONLY. If this is a renewal application, DO NOT SUBMIT A
BUDGET, you must submit financial forms a, b or c.
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N.C.G.S. 131F-3(3) Exemption Request Form NOTE: E-Postcards, 990-N (North Carolina Secretary of State)

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Completed 7 February 2021

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