Charitable Law Section Office 614.466.3181 Fax 614.466.9788 150 East Gay Street, 23rd Floor Columbus, Ohio 43215-3130 www.OhioAttorneyGeneral.gov REQUEST TO AMEND A CHARITABLE ORGANIZATION REGISTRATION STATEMENT THIS FORM MUST BE COMPLETED, AND NOTARIZED, BY EVERY CHARITABLE ORGANIZATION THAT: Is currently registered with the Ohio Attorney General’s Office pursuant to Ohio Revised Code Chapter 1716. Has submitted the required financial report(s) and paid the applicable registration fee(s). Wishes to amend the organization’s registration information prior to submitting the required renewal registration material. Name of organization: ___________________________________________________________________ Address: _____________________________________________________________________________ Street Address City Zip Code Organization Federal Employer Identification Number (EIN): ____________________________________ Briefly describe the amendment that you would like to make to your registration material. _____________________________________________________________________________________ _____________________________________________________________________________________ I, ____________________________________________________, being first duly sworn say that I am the (Please print Name) _____________________________________ of the above named organization and further state as follows: (Treasurer or Chief Fiscal Officer) 1. 2. 3. 4. I am the individual who has completed the foregoing Amendment Request; I have read the foregoing Amendment Request and know the contents thereof; The same is true to the best of my knowledge and belief; and This Amendment Request is made for the purpose of complying with the provisions of Chapter 1716 of the Ohio Revised Code. ______________________________________ Signature State of _____________________ ss: County of ___________________ Sworn to and subscribed before me this ______ day of _______________, _______. Seal ______________________________________ Notary Public (revised 2/11) American LegalNet, Inc. www.FormsWorkFlow.com