REGISTRATION FEE: (Upper right hand corner) is $25.

FEDERAL EMPLOYER ID #: This number is assigned to you by the IRS. It will also be required at the time a bank account is opened. It is obtained from the IRS by completing IRS Form SS4.

PLEASE TYPE OR PRINT: Do not use script.

LEGAL NAME OF ORGANIZATION: Type or print legal name EXACTLY as it appears on the governing document (Articles of Agreement, Articles of Incorporation, Constitution) of the organization.

MAIL ADDRESS: This is the address where correspondence and reporting forms from this office may be received. If this address changes, notify this office promptly.

LIST TRADE NAMES OR d/b/a IF ANY: List any and all that you may use when fundraising.

ADDRESS OF ANY OFFICE/RESIDENT AGENT IN THIS STATE: This space is provided for foreign corporations that MAY have an agent in this state. This is not a requirement.

FORM OF ORGANIZATION: If your organization was not created by a trust agreement or is not incorporated, the form of organization is "other" or "B". A copy of the governing document and all amendments must be submitted for all three categories. If incorporated in N.H., the governing document must be filed with the Secretary of State.

If the membership organization has been organized under the non-profit corporate laws of the District of Columbia (and in a few other states), and the Articles of Incorporation do not contain a provision for dissolution, IRS Form 1023 must be submitted in addition to the Articles of Incorporation.

If you have amended or will, in the future, amend your Articles of Agreement or Bylaws, it is necessary that you file a copy of the amended documents with this office.

NAMES, ADDRESSES, DAYTIME PHONE NUMBERS & TITLES: Furnish names and titles of all trustees, directors, and officers. The Board of Directors (trustees/directors) must have at least 5 voting members who are not of the same immediate family or related by blood or marriage. (See RSA 292:6-a)

Home address is the location at which that individual could be personally contacted, i.e., NOT a P. O. Box.

Daytime phone numbers are those numbers where that individual may be contacted between the hours of 8 AM and 5 PM.

FINANCIAL STATEMENT: A financial statement must accompany the Application. If the organization is newly formed submit a copy of the most recent bank statement showing the current balance and account number.

CONFLICT OF INTEREST POLICY: Effective August 10, 1996, every charitable trust is required to adopt a policy pertaining to conflict of interest. (See RSA 7:19 II and attached Addendum)

DISSOLUTION PROVISION: Required by the Attorney General's Office and the IRS.

IRS TAX EXEMPTION: Application for a tax-exempt status is received from the IRS by filing Form 1023 with them. Advise whether a tax-exempt status has been obtained from the IRS. If yes, furnish the NUMBER assigned under Section 501(c). If no, is it anticipated in the future?

DATE OF FISCAL YEAR END: This date IS NOT determined by the Department of Justice. The end-of-the-month selected should be a date that is convenient and suitable for your organization. The annual report form (NHCT-2A) will be mailed to you on this date.

CERTIFICATION: The ONLY acceptable signatures are those of the President and the Treasurer.

Signatures of the Business Manager, Clerk, Secretary, Executive Director, Chief Financial Officer will not be accepted and the form will be returned to you for proper execution.

In addition to the written signature, also type or print the name and title of the officers.

Download the Application Form  

  This symbol indicates the document is in Portable Document Format (PDF). To view PDF files, you will need the Adobe Acrobat Reader which is available for free from Adobe at http://www.adobe.com/prodindex/acrobat/readstep.html.