Form CO-1

CHARITABLE ORGANIZATION

JIM  RYAN

- REGISTRATION STATEMENT -

ATTORNEY GENERAL

PLEASE TYPE OR PRINT IN INK.  This registration statement is required by the Illinois Charitable Trust Act and "An

Act to Regulate Solicitation and Collection of Funds for Charitable Purposes."  Please answer all items which are applicable to

your organization.  If you are unable to answer any question fully in the space provided, please attach a sheet containing the remainder

of your answer.  No further registration statement is required, provided that every registered organization shall notify the Attorney

General within 10 days of any change in the information submitted herein.  One copy of this Registration Statement and attachments

are to be filed with the Office of the Attorney General, Charitable Trust and Solicitations Bureau, 100 West Randolph Street, Chicago,

Illinois 60601.

1.

This is a registration under:

Illinois Charitable Trust Act;

An Act to Regulate Solicitation and Collection of Funds for Charitable Purposes;

Both Acts

2.

Name of Organization

Telephone Number

Federal Employer ID#

Street and Number

City

County

State

Zip Code

3.

Type of legal entity (Corporation, Trust, Unincorporated Association or Other) and date, method and place organization

legally established.

If a foreign corporation, when was it authorized to do business in Illinois?

If a corporation, Illinois Secretary of State's File No.

* A copy of the Articles of Incorporation or Certificate of Authority issued by the Secretary of State must be attached.

4.

Name, address and telephone number of Illinois registered agent.

5.

Address of all offices in the State of Illinois.

6.

Date on which the annual period of the organization ends.

Month

Day

7.

State the purposes of the organization and purposes for which contributions are to be used. (Be specific)

8.

If the name under which the organization intends to solicit funds differs from the name listed in No. 2 provide name(s) under

which contributions will be solicited, and the reason for the use of such other name(s).

9.

If the organization has previously been registered with the Attorney General under either Act, give name under which registered

(if different than that shown in No. 2), last registration number, and date registered.

10.

Has the organization been registered with any other governmental authority to solicit contributions?

Yes

No

Name of authority and date of authorization.

Is such registration current?

Yes

No

11.

Has the organization or any of its officers, directors or trustees ever been enjoined or prohibited by any court or other

governmental agency from soliciting contributions, or is such action pending?

Yes

No

If "Yes", attach an explanation.

12.

Do you intend to use the services of a professional fund raiser as defined by "An Act to Regulate Solicitation and Collection of Funds

for Charitable Purposes"?

Yes

No

If "Yes", answer a, b, and comply with c below.

a.

Name and address of professional fund raiser(s):

b.

Has the professional fund raiser registered and filed a bond with the Office of the Attorney General as required?

Yes

No

c.

Attach copies of all contracts with professional fund raiser(s).

13.

Have any of organization's officers, directors, executive personnel, or have any of the organization's employees who have access to

funds, ever been charged with or convicted of a misdemeanor involving the misapplication or misuse of money of another, or any

felony?

Yes

No

If "Yes", give the following information:

NAME AND ADDRESS OF COURT

NATURE OF OFFENSE

DATE OF CONVICTION   (Mo./Yr.)

14.

State the board, group or individual having final discretion as to the distribution and use of contributions received.

15.

Will you use any of the following methods of solicitation?

Unordered Merchandise

Distribution or Sale of Seals

Telephone Appeals

Coin Collection Containers

Special Events

Ad Books

Direct Mail

Other – If other, attach an explanation.

16.

List name, mailing address and title of the chief executive or staff officer of the organization.

17.

Attach a list of names, mailing addresses, and daytime phone numbers of all officers and directors, or trustees of the organization.

18.

Has the United States Internal Revenue Service determined that this organization is tax exempt?

Yes

No

If "Yes", attach a copy of the determination letter. Is application pending?

Yes

No

* All organizations with tax exempt status or an application pending must attach a copy of

Federal Form 1023 "Application for Recognition of Exemption" or an exemption letter.

19.

Has organization's tax exempt status ever been questioned, audited, denied or cancelled at any time by any governmental agency?

Yes

No

If "Yes", attach the facts.

20.

Organizations which have been in operation for over one (1) year must attach a copy of the Federal return, or AG990IL if no Federal return was filed for each year the organization was in existence, completed in detail. Organizations which have been in operation less than one (1) year must attach a completed Financial Information Form CO-2, notarized.  Please note charitable organization's are required to maintain accurate and detailed accounting records.

21.

Approximate amount of contributions solicited or income received from persons in this State during the organization's last

annual accounting period

$

22.

EVERY REGISTERING ORGNAIZATION MUST ATTACH THE FOLLOWING APPLICABLE DOCUMENTS:

Corporation

The Article of Incorporation, or Certificate of Authority, Amendments and By-Laws

Unincorporated Association

Constitution and By-Laws

Testamentary Trust

Will, Probate Number and Decree of Distribution

Inter Vivos Trust

Instrument Creating Trust

NOTE:

The President and the Chief Financial Officer or other authorized officer both are required to sign. This must

be two different individuals.  If entry is a Trust, all Trustees must sign.

UNDER PENALTY OF PERJURY, THE UNDERSIGNED DECLARE AND CERTIFY THAT THE INFORMATION CONTAINED IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OUR KNOWLEDGE.

Signature

Title

Date

Signature

Title

Date

TO REGISTER WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE

ALL ORGANIZATIONS AND TRUSTS MUST SUBMIT:

1.

All fees due, including a $15.00 initial Registration Fee: payable to: "Illinois Charity Bureau Fund".

2.

"Charitable Organization Registration Statement" (Form CO-1), note all attachments required on form.

3.

A copy of the Federal Returns for past 3 years or if no federal returns were filed an AG990IL form for each year of the

organization's existence (if more than three years prior to registration attach 3 years subject to further requests); or if the

organization has been in existence  less than 1 year submit the "Charitable Organization Financial Information Form" (Form

CO-2)).

4.

A list of names, mailing addresses, and day time phone numbers of all Officers, Directors and/or Trustees.

5.

A copy of the IRS Determination Letter or if pending, submit a copy of IRS Form 1023 or 1024.

6.

If applicable, copies of all contracts with Professional Fund Raisers.

7.

If applicable, the "Religious Organization Exemption Form" (Form CO-3).

8.

IF A CORPORATION:  Illinois Articles of Incorporation or Articles of Incorporation other than those from Illinois and a

Certificate of Authority to do business from the Illinois Secretary of State.  All amendments to the Articles of Incorporation,

By-Laws of the Corporation.

9.

IF AN UNINCORPORATED ASSOCIATION:  Constitution and all amendments and By-Laws of the Association.

10.

IF A REPRESENTATIVE OF A PROBATE ESTATE (Containing Charitable Gifts):  Will and Letters of Office.

Inventory; Declarations of Trust for any trusts into which the Will pours over and all Amendments thereto.

11.

IF A CHARITABLE TRUST OR A LIVING INTER VIVOS TRUST: Declaration of Trust, and all Amendments thereto;

Inventory and recent accounting.

NOTE:  Illinois law requires charitable organizations and trusts to file an annual financial report each year and pay an

annual filing fee of $15 (and pay a $100 late report fee for each late report).

Direct the above registration materials, including all required fees payable to the "Illinois Charity Bureau Fund" to:

Office of the Illinois Attorney General

Charitable Trust Bureau

100 West Randolph Street,

Chicago, Illinois  60601-3175

(312) 814-2595

NOTE:

LATE REGISTRATION FEES:

-

The Solicitation for Charity Act requires that an organization which registers late must pay a late registration fee of $200.

-

The Trust Act and Solicitation Act both also imposes a $100 late annual financial report filing fee for each annual report filed late.

-

Reports mailed prior to registration are not considered filed.

-

All fees due must accompany registrations.

SEE:

CHARITABLE TRUST ACT

760 ILCS 55/1 et. seq.

SOLICITATION FOR CHARITY ACT

225 ILCS 460/1 et. seq.

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