The Georgia S100 form is a registration application for paid solicitors under the Georgia Charitable Solicitations Act. This form is essential for organizations seeking to solicit charitable contributions in Georgia, ensuring compliance with state regulations. Timely submission is crucial to avoid penalties, so fill out the form by clicking the button below.
The Georgia S100 form is a crucial document for individuals or organizations wishing to register as paid solicitors under the Georgia Charitable Solicitations Act. This form serves several important functions, including initial registration, reinstatement, and amendment of existing registrations. Each application requires a nonrefundable statutory fee, which varies depending on the type of application being submitted. For initial applications and reinstatements, the fee is set at $250, while amendments incur a fee of $15. It is essential to note that all registrations expire on December 31 each year, and failure to keep the form updated may lead to legal consequences. The form collects vital information such as the official name and address of the applicant, contact details, and the location of financial records. Additionally, applicants must disclose any prior legal issues or violations related to fundraising activities. Acknowledgments regarding compliance with various solicitation laws are also a significant part of the form, ensuring that applicants understand their responsibilities in handling charitable contributions. The completion of this form is not just a bureaucratic step; it is a commitment to ethical fundraising practices and transparency in the charitable sector.
Professional Licensing Boards and Securities Division
237 Coliseum Drive
Macon, GA 31217-3858
(478)207-2440
http://www.sos.ga.gov
Brian P. Kemp
Secretary of State
Georgia Charitable Solicitations Act
Paid Solicitor Registration
Shawnzia Thomas Division Director
EXECUTION PAGE
Statutory Fees
(Nonrefundable)
Make Check Payable to Georgia Secretary of State
INITIAL
APPLICATION
$250.00
REINSTATEMENT
Registration #: ___________________
AMENDMENT
$15.00
WARNING: The registration of a paid solicitor expires on December 31 of each year. Failure to keep this form current and file accurate supplemental information on a timely basis, or failure to keep accurate books and records or otherwise comply with provisions of the Georgia Charitable Solicitations Act of 1988, will constitute a violation of said Act and may result in disciplinary, administrative, injunctive or criminal action. INTENTIONAL MISSTATEMENTS OR OMISSIONS OF FACT MAY CONSTITUTE CRIMINAL VIOLATIONS.
1. Official Name:
Address of Applicant (Paid Solicitor):
Mailing Address (if different):
2. Contact Person:
Telephone:
Email address for official correspondence:
3. Location of Books and Records:
EXECUTION: On behalf of the applicant identified above, for the purpose of complying with the Charitable Solicitations Act of 1988 (O. C. G. A. 43- 17-1 et seq.) (“Act”), I hereby certify that the applicant is in compliance with said Act and irrevocably appoints the Secretary of State of the State of
Georgia the agent for the applicant upon whom may be served any notice, process or pleading in any action or proceeding against the applicant arising out of, or founded upon, a violation or an alleged violation of said Act. The applicant hereby consents that any such action or proceeding against said applicant may be commenced in any court of competent jurisdiction and proper venue within the State of Georgia by service of process upon Secretary of State with the same effect as if the applicant was a resident of the State of Georgia and had been personally served with process. The undersigned hereby verifies that he had executed this form on behalf of, and with the authority of, said applicant. The undersigned and applicant represent that the information and statements contained herein, including the exhibits attached hereto, and other information filed herewith, are made a part hereof, are current, true and complete. The undersigned and applicant further represent that to the extent any information previously submitted is not amended, such information is currently accurate and complete.
Name of authorized Executive Officer (please type or print):
Signature of Executive Officer:
Date:
Title:
Official Witness (Notary)
THIS PAGE MUST ALWAYS BE COMPLETED IN FULL with original manual signature and notarization with seal. If filing an initial registration or reinstatement of registration, submit entire application. To amend, circle number(s) being amended. Registration does not become effective until all information on this application is received and approved. All paid solicitor registrations expire on December 31.
Form S100 Revised Dec 2013
Page 1 of 9
APPLICANT’S NAME:
To amend, circle numbers being amended and file with a completed execution page (S100 page 1)
4.Status of registration in other jurisdictions
Enter “1” for pending registrations, “2” if already registered, and leave blank if not registered.
AL
DE
KS
MO
NM
RI
WA
AK
AR
AZ
CA
CO
CT
DC
FL
GA
HI
IA
ID
IL
IN
KY
LA
MA
MD
ME
MI
MN
MS
MT
NC
ND
NE
NH
NJ
NV
NY
OH
OK
OR
PA
PR
SC
SD
TN
TX
UT
VA
VT
WI
WV
WY
ORGANIZATION
Date of Formation:
Place of Filing:
6. Applicant is a:
Corporation
Proprietorship
Partnership
Limited Liability Company
Other:
7.If FOREIGN Corporation, date qualified to transact business in Georgia:
8.Will applicant have physical possession or legal control over any contributions collected in or from the state of Georgia?
YES
NO
If yes, applicant must attach the following to this application:
(a)Fiscal year-end financial statement for period ending one year prior to date of filing, or for the preceding fiscal year if fiscal year has ended within 90 days of this filing OCGA 43-17-3(c)(3). ). Such financial statement must be prepared in accordance with generally accepted accounting principles.
(b)Surety bond satisfactory to the Secretary of State in the sum of $10,000 payable to the State of Georgia OCGA 43-17-4(a).
9.BRIEF DESCRIPTION OF BUSINESS. Provide a brief description of the general character of the business to be conducted or proposed to be conducted by the applicant:
CHAPTERS, BRANCHES, AND AFFILIATES
List the name and address of each affiliated branch or chapter
located in the State of Georgia and the directors of each such branch or chapter.
Attach additional sheets as needed.
Address
Telephone
Designated Supervisor
Page 2 of 9
BACKGROUND INFORMATION
NOTE: (1) For the purpose of the following questions the term “executive officer” means the chief executive officer, the president, the principal financial officer, the principal operation officer, the treasurer or any other person performing similar functions.
(2)All YES answers to questions must be fully explained on page 4 of the application (attach additional sheets as needed) and you must complete Page 6 for a background investigation.
10.In the past ten years has the applicant, executive officer, or control person been convicted of or pled guilty or nolo contendere (no contest) to a felony or misdemeanor which:
(a) Involves the solicitation or acceptance of charitable contributions or the making of a false oath, the making of a false report, bribery, perjury, burglary, or conspiracy to commit any of the foregoing offenses?
(b) Arises out of the conduct of solicitation of contributions for a charitable organization?
(c)Involves the larceny, theft, robbery, extortion, forgery, counterfeiting, fraudulent concealment, embezzlement, fraudulent conversion, or misappropriation of funds?
(d)Involves murder or rape?
(e)Involves assault or battery if such person proposes to be engaged in counseling, advising, housing, or sheltering individuals? Or
(f)Pled guilty or nolo contendere (no contest) to any other felony offense?
11. Has any court:
(a)in the past ten years enjoined the applicant or a executive officer in connection with any aspect of the fundraising business?
(b)ever found that the applicant or executive officer was involved in a violation of any state or federal law regarding fundraising or any other deceptive practice?
12. Has any local, state or federal government agency:
(a)ever found the applicant or executive officer to have made a false statement or omission or been dishonest, unfair or unethical?
(b)ever found the applicant or executive officer to have been involved in a violation of a fundraising law?
(c)ever found the applicant or executive officer to have been a cause of any fundraising organization having its authorization to do business denied, suspended, revoked or restricted?
(d)in the past ten years entered an order against the applicant or a executive officer in connection with any fundraising statute or deceptive practices?
(e)ever denied, suspended, or revoked the applicant’s or a executive officer’s registration or license, prevented it from association with a fundraising organization, or otherwise disciplined it by restricting its activities?
(f)ever revoked or suspended the applicant’s or a executive officer’s license as an attorney or accountant?
13.Is the applicant or executive officer now the subject of any proceeding that could result in a yes answer to any question contained herein?
14.Does the applicant have any unsatisfied judgments or liens against it or has it filed for any type bankruptcy?
ACKNOWLEDGEMENTS
By submitting this application, the applicant acknowledges the following statutory requirements:
(a)SOLICITATION CONTRACT REQUIRED. [OCGA 43-17-3(e)(1)] There must be a written contract between the paid solicitor and each charitable organization on whose behalf solicitations are conducted.
(b)SOLICITATION NOTICE. [OCGA 43-17-3(f)] A solicitation notice and a copy of each solicitation contract must be filed with the Secretary of State prior to the commencement of each solicitation campaign.
(c)POINT OF SOLICITATION DISCLOSURE. [OCGA 43-17-8] Each employee, agent, independent contractor or representative of the paid solicitor must provide at the point of solicitation the name and location of the paid solicitor, the name and location of the charitable organization for which the solicitation is being made, and a statement that a full and fair description of the charitable program and a financial statement or summary are available upon request.
(d)ACCOUNTING TO CHARITABLE ORGANIZATION. [OCGA 43-17-3(g)] Within 90 days after a solicitation campaign has been completed, and on the anniversary of the commencement of a solicitation campaign lasting more than one year, the paid solicitor shall account in writing to the charitable organization, and the Secretary of State, for all contributions and expenses paid.
(e)COLLECTIONS AND DEPOSITS. [OCGA 43-17-3(h)] Each monetary contribution received by the applicant shall, in its entirety and within three (3) business days of its receipt, be deposited in an account at a federally insured financial institution. Such account shall be in the name and under the sole control of the charitable organization.
(f)EXPIRATION. [OCGA 43-17-3(c)(6)] Registration for a paid solicitor, if granted, expires on December 31 of the year issued, and if not renewed shall terminate without further notice to the applicant.
(g)COMMERCIAL COVENTURERS. [OCGA 43-17-6] Any charitable sales promotion in conjunction with a commercial coventurer must be initiated only after a written contract that complies with the Code is entered into between the charitable organization and the commercial coventurer.
(h)AMENDMENTS TO REGISTRATION. [OCGA 43-17-3(c)(7)] Registration must be current and up to date at all times and must be amended within 30 days to reflect any material changes in operations of the paid solicitor.
Page 3 of 9
(i)RECORDS. [OCGA 43-17-3(i)(1)] Solicitation campaign records must be prepared and maintained for no less than three years and be available for inspection by representatives of the Secretary of State.
(j)MISAPPROPRIATION OF FUNDS AND FRAUDULENT CONDUCT. [OCGA 43-17-12] The Georgia Charitable Solicitations Act of 1988 establishes that it is a felony to engage in fraudulent conduct or to misappropriate, convert or illegally withhold contributions collected pursuant to the Act.
EXPLANATION TO APPLICATION QUESTIONS
This section must be used to explain any YES answers on the previous pages.
It may also be used to explain the answers to any other questions on the application.
Explanation:
Page 4 of 9
CONTROL PERSONS
The applicant must provide the following information for each person who directly or indirectly, has the power to direct or cause the direction of the management and policies of the applicant whether through the authority of voting securities, by contract or otherwise. The term control person includes, but is not limited to, each general partner, limited partner, director, affiliate or executive officer or person holding similar position.
Make additional copies of this form as needed.
(Please type or print)
Name:
Address:
City:
State:
Zip Code:
Date of Birth:
Social Security Number:
The person named above MUST provide a ten year employment history
beginning with the most recent employment.
Attach separate sheets if needed.
All persons who have custody of charitable donations must submit to a criminal background check.
By signing this form the person named above authorizes the Secretary of State to conduct a criminal history check pursuant to the paid solicitor’s registration in the State of Georgia.
Signature of Control Person
This
Day of
Signature
Page 5 of 9
Georgia Bureau of Investigation
Georgia Crime Information Center
Consent Form
I hereby authorize the Office of Secretary of State – Charities Division to receive any Georgia criminal history record information pertaining to me which may be in the files of any state or local criminal justice agency in Georgia.
_____________________________________________________________________________
Full Name (print)
_____
__________________
_________________________
Sex
Race
Date of Birth
Social Security Number
___________________________________________________
Date
---------------------------------------------------------------------------------------------------------------------
Special employment provisions (check if applicable):
Employment with mentally disabled (Purpose code ‘M’)
Employment with elder care (Purpose code ‘N’)
Employment with children (Purpose code ‘W’)
Employment with criminal justice agency – civilian (Purpose code ‘J’) Employment with criminal justice agency – P.O.S.T. certified (Purpose code ‘Z’)
One of the following must be checked:
This authorization is valid for 90/180/_____ (circle one) days from date of signature.
I, _______________________________________________ give consent to the above named to
perform periodic criminal history background checks for the duration of my employment with this company.
Page 6 of 9
AFFIDAVIT OF APPLICANT
I certify and declare that I am of good moral character and that all information contained in this application is true and correct, to the best of my knowledge. I understand that any willful omission or falsification of pertinent information required in the application is justification for the denial, suspension, or revocation of my registration by the Commission. I further swear and affirm that I have read and understand the current state laws and rules and regulations of the Georgia Paid Solicitor Regulatory Commission and I agree to abide by these laws and rules, as amended from time to time.
By signing this application, electronically or otherwise, I hereby swear and affirm one of the following to be true and accurate pursuant to O.C.G.A. § 50-36-1:
1) _______ I am a United States citizen 18 years of age or older. Please submit a copy of your current Secure and
Verifiable Document(s) such as driver’s license, passport, or document as indicated on pages 7 & 8 of this application.
2) _______ I am not a United States citizen, but I am a legal permanent resident of the United States 18 years of
age or older, or I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act 18 years of age or older with an alien number issued by the Department of Homeland Security or other federal immigration agency. Please submit a copy of your current immigration document(s) which includes either your Alien number or your I-94 number and, if needed, SEVIS number.
I also understand that if I have made a false statement on the application, or if I am found to have been convicted of a felony and have not had all of my civil rights restored pursuant to the law, the Commission may suspend my registration without a prior hearing. I shall be entitled to a hearing after the suspension of my registration.
I understand that I must maintain the records required by the Commission, and I shall make the records available for inspection by the Georgia Paid Solicitor Regulatory Commission, or its authorized representative, at any time during normal business hours.
In making the above attestation, I understand that any failure to make full and accurate disclosures may result in disciplinary action by the Georgia Paid Solicitor Regulatory Commission and/or criminal prosecution.
_____________________________________________________
Signature of ApplicantDate
Print Applicant’s Name
Personally appeared before me, the undersigned official authorized to administer oaths, comes
_______________________________who deposes and swears that he/she is the person who executed this
(Applicant’s Name)
application for a license by examination for Paid Solicitor in the State of Georgia; and that all of the statements
herein contained are true to the best of his/her knowledge and belief.
Sworn to and subscribed before me this ______ day of ___________________, 2________
Notary Public Signature ________________________________
________________________________
County
State
My Commission Expires ______________________
(seal)
Page 7 of 9
APPLICANT: PLEASE CHECK THE FORM OF IDENTIFICATION BELOW THAT YOU POSSESS. RETURN THIS FORM ALONG WITH A COPY OF YOUR APPROPRIATE DOCUMENTATION.
________________________________________
Name
Secure and Verifiable Documents Under O.C.G.A. § 50-36-2
Issued August 1, 2011 by the Office of the Attorney General, Georgia
The Illegal Immigration Reform and Enforcement Act of 2011 (“IIREA”) provides that “[n]ot later than
August 1, 2011, the Attorney General shall provide and make public on the Department of Law’s website a
list of acceptable secure and verifiable documents. The list shall be reviewed and updated annually by the Attorney General.” O.C.G.A. § 50-36-2(f). The Attorney General may modify this list on a more frequent
basis, if necessary.
The following list of secure and verifiable documents, published under the authority of O.C.G.A. § 50-36-2, contains documents that are verifiable for identification purposes, and documents on this list may not necessarily be indicative of residency or immigration status.
_____ A United States passport or passport card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A United States military identification card [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A driver’s license issued by one of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____An identification card issued by one of the United States, the District of Columbia, the Commonwealth of Puerto
Rico, Guam, the Commonwealth of the Northern Marianas Islands, the United States Virgin Island, American Samoa, or the Swain Islands, provided that it contains a photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A tribal identification card of a federally recognized Native American tribe, provided that it contains a
photograph of the bearer or lists sufficient identifying information regarding the bearer, such as name, date of birth, gender, height, eye color, and address to enable the identification of the bearer. A listing of federally recognized Native American tribes may be found at: http://www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/TribalDirectory/index.htm [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A United States Permanent Resident Card or Alien Registration Receipt Card [O.C.G.A. § 50-36-2(b)(3); 8
CFR § 274a.2]
_____An Employment Authorization Document that contains a photograph of the bearer [O.C.G.A. § 50-36-2(b)(3); 8
_____A passport issued by a foreign government [O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
Page 8 of 9
_____A Merchant Mariner Document or Merchant Mariner Credential issued by the United States Coast Guard
[O.C.G.A. § 50-36-2(b)(3); 8 CFR § 274a.2]
_____A Free and Secure Trade (FAST) card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
_____A NEXUS card [O.C.G.A. § 50-36-2(b)(3); 22 CFR § 41.2]
_____A Secure Electronic Network for Travelers Rapid Inspection (SENTRI) card [O.C.G.A. §50-36-2(b)(3); 22 CFR
§ 41.2]
_____A driver’s license issued by a Canadian government authority [O.C.G.A. § 50-36-2(b)(3); 8 CFR §
274a.2]
_____A Certificate of Citizenship issued by the United States Department of Citizenship and Immigration
Services
(USCIS) (Form N-560 or Form N-561) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
_____A Certificate of Naturalization issued by the United States Department of Citizenship and Immigration
Services (USCIS) (Form N-550 or Form N-570) [O.C.G.A. § 50-36-2(b)(3); 6 CFR § 37.11]
_____In addition to the documents listed herein, if, in administering a public benefit or program, an agency is required
by federal law to accept a document or other form of identification for proof of or documentation of identity, that document or other form of identification will be deemed a secure and verifiable document solely for that particular program or administration of that particular public benefit. [O.C.G.A. § secure and 50-36-2(c)]
Page 9 of 9
Filling out the Georgia S100 form requires careful attention to detail. Each section must be completed accurately to ensure compliance with state regulations. After completing the form, it must be submitted along with the appropriate fees. The registration is not effective until all information is received and approved by the Secretary of State.
The Georgia S100 form is an application for registration as a paid solicitor under the Georgia Charitable Solicitations Act. This form is required for individuals or organizations soliciting charitable contributions in Georgia. It ensures compliance with state laws governing fundraising activities.
Any paid solicitor planning to solicit contributions on behalf of a charitable organization in Georgia must file the S100 form. This includes corporations, partnerships, and other entities engaged in fundraising activities.
There are several fees associated with the S100 form:
These fees are nonrefundable and must be paid to the Georgia Secretary of State.
The registration of a paid solicitor expires on December 31 of each year. It is crucial to renew the registration annually to avoid any violations of the Georgia Charitable Solicitations Act.
Providing inaccurate information can lead to serious consequences. Intentional misstatements or omissions may constitute criminal violations. It is essential to ensure that all information submitted is current, true, and complete.
If the applicant will have physical possession or legal control over contributions, the following documents must be attached:
Yes, a written contract is required between the paid solicitor and each charitable organization for which solicitations are conducted. This contract must comply with the Georgia Charitable Solicitations Act.
Solicitation campaign records must be maintained for a minimum of three years. These records must be available for inspection by representatives of the Secretary of State.
Non-compliance with the Georgia Charitable Solicitations Act may result in disciplinary, administrative, injunctive, or criminal actions. It is vital to adhere to all requirements to avoid these potential penalties.
Failing to provide the official name of the applicant. This is a critical piece of information that must be accurate.
Not including a valid mailing address if it differs from the applicant's address. Ensure both addresses are clearly stated.
Leaving the contact person field blank. This person is essential for communication regarding the application.
Neglecting to specify the status of registration in other jurisdictions. This information is necessary for compliance verification.
Overlooking the requirement to provide a fiscal year-end date. This date is important for financial reporting.
Not attaching the necessary financial statements if the applicant has legal control over contributions. This could lead to delays in processing.
Failing to complete the execution page properly. This page must have original signatures and notarization.
Submitting the application without ensuring that all information is current and accurate. Inaccurate information can result in legal consequences.
The Georgia S100 form is an essential document for individuals or organizations wishing to register as paid solicitors under the Georgia Charitable Solicitations Act. However, several other forms and documents are often required in conjunction with this registration process. Below is a list of these documents, each accompanied by a brief description to provide clarity on their purpose.
Understanding these documents is crucial for anyone looking to navigate the registration process effectively. Each form serves a specific purpose and contributes to compliance with state regulations, ensuring that charitable solicitations are conducted legally and ethically.
The Georgia S100 form shares similarities with the IRS Form 1023, which is used by organizations seeking tax-exempt status under Section 501(c)(3) of the Internal Revenue Code. Both forms require detailed information about the organization, including its purpose, activities, and financial practices. The S100 form focuses on the registration of paid solicitors, while Form 1023 emphasizes charitable organizations. Both documents necessitate a commitment to transparency and compliance with state or federal regulations.
Another document comparable to the Georgia S100 is the State of California's Form RRF-1, which is the Registration Renewal Form for charitable organizations. Like the S100, RRF-1 requires organizations to disclose their financial information and operational details. Both forms serve to ensure that organizations adhere to state laws governing fundraising activities. They also emphasize the importance of maintaining accurate records and timely submissions to avoid penalties.
The Texas Application for Charitable Organization Registration is another similar document. This application, like the S100, mandates that organizations provide comprehensive information about their fundraising practices and financial accountability. Both forms aim to protect the public by ensuring that charities operate transparently and ethically. They also require notarized signatures to validate the information provided.
The Florida Department of Agriculture and Consumer Services requires a similar form, the Charitable Organization Registration Application. This document, akin to the S100, collects essential information regarding the organization’s structure, financial status, and solicitation practices. Both forms are designed to promote compliance with state regulations and protect the interests of donors and the public.
The New York State Charities Registration Form also mirrors the Georgia S100 form in its purpose and requirements. Both documents require detailed disclosures about the organization’s finances and operations. They aim to ensure that organizations are accountable for their fundraising activities and maintain compliance with state laws. The necessity for accurate and truthful reporting is a common thread between these forms.
Lastly, the Illinois Charitable Organization Registration Form is comparable to the Georgia S100. Both forms require organizations to provide information about their fundraising activities, financial statements, and compliance with applicable laws. They serve to protect the public interest by ensuring that charitable organizations operate transparently and responsibly. The emphasis on accurate record-keeping and reporting is a shared priority for both documents.
When filling out the Georgia S100 form, it's essential to follow specific guidelines to ensure your application is processed smoothly. Here are six things you should and shouldn't do:
Understanding the Georgia S100 form is essential for anyone looking to operate as a paid solicitor in the state. However, several misconceptions often arise regarding this important document. Here are five common misunderstandings:
By addressing these misconceptions, applicants can better navigate the requirements of the Georgia S100 form and ensure compliance with the Georgia Charitable Solicitations Act.
The Georgia S100 form is used for the registration of paid solicitors under the Georgia Charitable Solicitations Act.
Initial applications and reinstatements require a nonrefundable fee of $250.00, while amendments cost $15.00.
Registration must be renewed annually, as it expires on December 31 of each year.
All information provided must be accurate and complete. Misstatements or omissions can lead to serious legal consequences.
Each paid solicitor must maintain accurate records of contributions and expenses for at least three years.
Before starting any solicitation campaign, a written contract with the charitable organization is mandatory.