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WA ST Secretary of State's Office 11/6/2019
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WA ST Secretary of State's Office 11/6/2019
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Last modified
11/19/2019 10:29:54 AM
Creation date
11/19/2019 10:29:37 AM
Metadata
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Template:
Contracts
Contractor's Name
WA ST Secretary of State's Office
Approval Date
11/6/2019
Department
Parks
Department Project Manager
Lindsay Roe
Subject / Project Title
Fund 151 Charity Registration Application
Tracking Number
0002051
Total Compensation
$60.00
Contract Type
Agreement
Retention Period
6 Years Then Destroy
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Registration# <br /> ORGANIZATION'S FINANCIAL PREPARER <br /> PERSON OR ORGANIZATION THAT PREPARES,REVIEWS, OR AUDITS FINANCIAL <br /> INFORMATION,IF ANY,OR PERSON OR ENTITY THAT COMPLETED THE SOLICITATION REPORT <br /> If the Solicitation Report for the preceding,completed accounting year has been filled out on page 3 the below information must be provided. <br /> Please check one: a Organization(section 1) ❑ Individual(section 2) <br /> (Section 1)Organization <br /> Organization Name: City of Everett <br /> Representative's First and Last Name: Susy Haugen Title: Finance Director <br /> Address 2930 Wetmore Avenue City Everett State WA Zip 98201 <br /> (Section 2)Individual <br /> Rae Ann Nielsen Budget Manager <br /> Name: Title: <br /> 2930 Wetmore Avenue Everett WA 98201 <br /> Address City State Zip <br /> ORGANIZATION'S LEGAL INFORMATION <br /> Has the charitable organization or any individual in its registration been subject to any legal action in which a judgment <br /> or final order was entered, or action is currently pending?(Check one) ❑ Yes e No If Yes,please complete below <br /> and enclose documentation with the registration. <br /> Court(Jurisdiction): Case Number: <br /> Title of Legal Action: Date of Legal Action: <br /> COMMERCIAL FUNDRAISERS <br /> Does the Organization use one or more Commercial Fundraisers to solicit contributions in WA? <br /> (Check one) ❑ Yes e No If Yes,please complete the fields below for each contracted and sub-contracted commercial <br /> fundraiser.If necessary,attach an additional sheet. <br /> Name of Company: Fundraiser Registration Number: <br /> Address City State Zip <br /> Phone: <br /> 5 CH Reg Revised 1.2018 <br />
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