Form Ct Nrp 1 – Fill Out and Use This PDF

The registration period is September 1 to August 31.

MAIL TO:

After August 31, a new registration is required.

Office of the Attorney General

Registry of Charitable Trusts

P.O. Box 903447

A CHECK IN THE AMOUNT OF $20 MADE PAYABLE TO

Sacramento, CA 94203-4470

DEPARTMENT OF JUSTICE MUST ACCOMPANY THIS

STREET ADDRESS:

REGISTRATION FORM

1300 I Street

Sacramento, CA 95814

Telephone: (916) 445-2021

WEBSITE ADDRESS:

www.oag.ca.gov/charities

Proof of California Franchise Tax Board exempt status must be attached to this

(For Registry Use Only)

registration application. This application will otherwise be deemed deficient and

returned to the organization.

Raffle Registration Number: __________________________

Name of Organization

Provide at least one of the following:

Federal Employer Identification Number (FEIN):

Address of Organization

City or Town, State and ZIP Code

Corporate Number:

E-mail Address

Organization Number:

Telephone Number

Fax Number

State Charity Registration Number:

23701a

Labor, agricultural, or horticultural organizations

23701g Nonprofit pleasure and recreation clubs

23701b

Fraternal beneficiary societies, orders or associations

23701k Religious or apostolic corporations having common or

23701d

Religious, charitable, scientific, testing for public safety,

23701l Domestic fraternal societies, orders or associations

literary, educational, amateur sports or prevention of cruelty to

children or animals organization

23701e

Business leagues, chambers of commerce, real estate

23701t Homeowners and associations

boards, and boards of trade

23701f Civic leagues, social welfare organizations and local

23701w Veterans organizations

employee organizations

By signing this application for registration, I hereby certify all of the following:

1.

Applicant is a private, nonprofit organization, 2.

Applicant has been qualified to conduct business in the State of California

for at least one year prior to the raffle first held and 3.

all information provided on this application is true and correct.

Signature of Authorized Officer or Director Who Prepared This Form

Date

Printed Name of Authorized Officer or Director

Title of Authorized Officer or Director