Section 400

under penalty of perjury and being sworn on oath state that I am

(strike out) the CORPORATE PRESIDENT, a GENERAL PARTNER or the SOLE PROPRIETOR of the registrant professional fund raiser.

Section 400.APPENDIX B Professional Fund Raiser Forms

Section 400.ILLUSTRATION A Registration Statement and Instructions

Form PFR-01

PROFESSONAL FUND RAISER

REGISTRATION STATEMENT

JIM RYAN

ATTORNEY GENERAL

For Fiscal Year July 1, ___Through June 30, ___

1. □ A NEW REGISTATION □ RE REGISTRATION □ CHANGE □ ADDITION AS OF	/ /
2. □ INDIVIDUAL □ PARTNERSHIP or □ CORPORATION Attach: Partnership Agreement or Articles of Incorporation

NAME of REGISTRANT

PFR NUMBER

02-

ADDRESS

PHONE NUMBER

( ) -

CITY, STATE, ZIP CODE

FEDERAL ID NUMBER

3. NAME OF CHIEF MANAGEMENT PERSON(S)		TITLE
(Attach Schedules as needed)		TITLE

4. NAME & ADDRESS OF ILLINOIS REGISTERED AGENT: (Address must be a street address for service)
Name:	Address:

5. LIST ALL PRINCIPAL PARTIES, OFFICERS, DIRECTOR, EXECUTIVE PERSONNEL, AND OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK (ATTACH SCHEDULE as needed INDICATING NAME, STREET ADDRESS, TITLE, % OF INTEREST, BIRTH DATE, DRIVERS LICENSE #, STATE OF ISSUE for each person listed).

Name

Title

Name

Title

Address

□ Officer □ Director □ Executive Employee

□ Owner ____%

Birth Date

/ /

□ Owner ____%

Birth Date

/ /

Drivers License #

State

Drivers License #

State

Name

Title

Name

Title

Address

□ Of ricer □ Director □ Executive Employee

□ Officer □ Director □ Executive Employee

□ Owner ____%

Birth Date

/ /

□ On nor ____%

Birth Date

/ /

Drivers License #

State

Drivers License #

State

6. WERE ALL PROFESSIONAL SOLICITORS FURNISHED A 1099 OR W2 LAST YEAR? □ Yes □ No

IF NO, EXPLAIN IN DETAIL. COMPLETE AND ATTACH FORM PS-01.

7. HAVE ANY OF THE FIRM'S PRINCIPAL PARTIES, EMPLOYEES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF TEN PERCENT OR MORE OF THE CAPITAL STOCK OR THEIR RELATIONS EVER BEEN CONVICTED OF A MISDEMEANOR INVOLVING THE MISAPPROPRIATION OR MISUSE OF MONEY OF ANOTHER, OR OF ANY FELONY? □ Yes □ No

IF "YES", INDICATE WHO WAS CONVICTED, THE NATURE of OFFENSE, DATE of CONVICTION, and NAME and ADDRESS of COURT.

8. LIST THE INTEREST OF ALL PRINCIPAL PARTIES, OFFICERS, DIRECTORS, EXECUTIVE PERSONNEL, OWNERS OF REGISTRANT AND THEIR FAMILY MEMBERS IN ANY OTHER FIRMS PROVIDING GOODS OR SERVICES USED IN FUND RAISING.

NATURE OF BUSINESS	NAME OF PARTY	% INTEREST	NAME & STREET ADDRESS OF BUSINESS

9. COMPLETE & ATTACH FORM PFR-06 FOR ALL CHARITIES HAVING CONTRACTS WITH PFR.

ATTACH THE FOLLOWING AS A PART OF REGISTRATION AND INDICATE BY AN "X" THOSE ATTACHED:

□ Partnership Agreement or Articles of Incorporation of professional Fund Raiser (PFR).

□ Certificate of Authority to Transact Business in Illinois (Out of state PFRs only).

□ Form CS-6 (PFR Bond).

□ Form PFR-06 (List of Charities for whom fund Raising services are to be provided.).

□ Form PS-01 (For all Solicitors employed by PFR).

□ List all business locations, other than above, used for fundraising. (attach a schedule indicating street address, city, state).

□ All schedules and explanations for any of the above questions.

□ Copies of all Fund Raising Contracts with Charities including Amendments, and Extensions.

NOTE: VERIFICATION MUST BE BY THE CORPORATE PRESIDENT, A GENERAL PARTNER OR THE SOLE PROPRIETOR

I have read the forgoing registration statement and personally know the contents thereof to be true, and each and every attachment, attached form and attached schedule, the content thereof as stated by me and filed by me with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon. I herebv further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois.

Subscribed and sworn to before me.
This	day of	, 19
			(Signature)

Notary Public			(Print Name & Title)

Attach as many copies of this form and all schedules needed to complete your registration.

Send completed registration to:

Attorney General's Office, Charitable Trust Bureau, 100 West Randolph, 3rd Floor, Chicago, Illinois 60601

DOCUMENTS A PROFESSIONAL FUND RAISER MUST SUBMIT TO REGISTER

WITH THE ILLINOIS ATTORNEY GENERAL'S OFFICE

ALL PROFESSIONAL FUND RAISERS MUST SUBMIT:

1. $100.00 Registration Fee. Check or Money Order payable to "Illinois Charity Bureau Fund" attached to Form PFR-01.

2. "Professional Fund Raiser Registration Statement" (Form PFR-01).

3. "Professional Fund Raiser (PFR) List of Charities & Contracts" (Form PFR-06).

4. A copy of all contracts listed on Form PFR-06 along with the $25.00 Annual Filing Fee for Each Contract Filed or on File. Check or Money Order payable to the "Illinois Charity Bureau Fund" attached to Form PFR-06.

5. "Professional Fund Raisers Bond" (Form CS-6) This Form must be filed by all Professional Fund Raisers that have access to or control of funds raised.

6. "Professional Solicitor Registration Statement" (Form PS-01) This Form must be filed for each Solicitor employed by the PFR.

7. Partnership Agreement or Articles of Incorporation of Professional Fund Raiser.

8. Certificate of Authority to Transact Business in Illinois. This must be filed by out of state corporations only.

9. List of all business locations used for fund raising. (Attach a schedule indicating street address, city, state).

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

Office of the Attorney General

Charitable Compliance Section

100 West Randolph Street, 3rd Floor

Chicago, Illinois 60601

(312) 814-2595

Note: Registrations and contracts not filed timely must by law pay a late filing fee of $1,000.00 for each contract that is not on file with this office.

(Source: Added at 24 Ill. Reg. 14684, effective September 21, 2000)