ORGANIZATION INFORMATION

Organization Name:

Registration Number:

Also known as Names:

Name
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Purpose/Mission of the Organization:

FEIN Number:

Federal Tax Exempt Status:

Federal Status Type:

If Federal Tax-Exempt status has been granted, attach a copy of the Organization's IRS Determination Letter:

IRS Determination Letter

UBI Number:

Is this Charitable Organization associated with any Corporation or LLC?

State of Incorporation/Formation:

Jurisdiction:

Status:

Renewal Date:

Is Optional Charities?

ORGANIZATION INFORMATION

Organization Name:

Registration Number:

Federal Status Type:

Summarize Charitable Purpose:

Establishment of Trust:

Articles of Incorporation and Bylaws

Trust Agreement

Last Will and Testament

Probate Order

Status:

FEIN Number:

Federal Tax Exempt Status:

Jurisdiction:

Mixed Trust:

Renewal Date:

UBI Number:

IRS Determination Letter

TRUST INSTRUMENT

Name Of Corporation:

Date of incorporation:

Trust Agreement/Inter Vivos of:

Date of establishment:

Estate Of:

County Probated:

Probated Number:

Probated date:

IRS Determination Letter

TRUST BENEFICIARY

Charity Name	Address

CONTACT INFORMATION

Organization Email:

Is Foreign Contact:

Country Code:

Mailing Address:

Street Address:

Do you use any other addresses for Solicitation:

Organization Website:

Phone Number:

Ext:

SURETY BOND

Has the Organization submitted proof of a surety bond in the amount of $25,000 to the Secretary of State?

Bond Expiration Date:

FINANCIAL INFORMATION

Has Organization completed a full accounting year?-

First Accounting Year End Date:

Accounting Year Beginning Date:

Accounting Year Ending Date:

Beginning Gross Assets :

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REVENUE

All Contributions Received :

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Average Percent to Charity :

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Gross Contributions from Solicitations :

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Gross Revenue from All Other sources :

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Total Dollar Value of Gross Receipts :

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Total Revenue :

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Grants, Contributions and Program Services :

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Expenses

Amount of Funds Distributed to Charities:

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Gross Expenditures from Program Services :

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Total Gross from All Expenditures :

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Compensation of officers/directors/trustees :

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Total Expenses :

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ASSETS

Ending Gross Assets :

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SOLICITATION COMMENTS

Comments:

PERCENT TO PROGRAM SERVICES

Percent to Program Services :

FINANCIAL HISTORY

IRS tax documents

IRS tax documents Type:

IRS Tax Document

DID THE ORGANIZATION SOLICIT OR COLLECT CONTRIBUTIONS IN WA DURING THE ACCOUNTING YEAR REPORTED?

Solicit or collect contributions:

Contributions in WA:

IS THE ORGANIZATION REGISTERED TO FUNDRAISE OUTSIDE OF WA?

Is the organization registered to fundraise outside of WA:

Fundraise outside of WA:

EMPLOYEES RECEIVING THE GREATEST COMPENSATION

Does the Organization pay any of its officers or employees?-

First Name	Last Name

PERSONS ACCEPTING RESPONSIBILITY

OFFICERS DIRECTORS TRUSTEES

Current Officers or Persons Accepting Responsibility for the Organization

First Name	Last Name	Title	Phone #	Address	Responsible for CFR in WA

FINANCIAL PREPARER

Full Name:

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Business Name:

Title:

Mailing Address:

Legal Information

Do you have any Legal Actions? -

Court (Jurisdiction)	Case #	Title of Legal Action	Date of Legal Action

Legal Actions

COMMERCIAL FUNDRAISER

Is Commercial Fundraiser:

FEIN Number	UBI Number	Fundraiser Name	Fundraiser Address

CHARITY CLIENTS

FEIN Number	UBI Number	Charity Name	Charity Address

No Charities Selected

TRUST DIRECTORY

Complete this section if the organization wishes to be included in the Washington Charitable Trust Directory ? :

Type of organization :

Both Grantmaker and Grantseeker

Purpose :

Does the organization accept unsolicited applications?:

Grants are made to :

Average grant size :

Geographic service area :

Local :

Other :

Suggested initial approach for grant seekers :

E-mail :

Other :

Date of Adoption

Date of Adoption:

DATE OF CLOSURE

Date of closure: {{(modal.EffectiveClosureDate |date : 'MM/dd/yyyy')=='01/01/0001'?'':(modal.EffectiveClosureDate |date : 'MM/dd/yyyy')}}

CLOSURE REASON