OFFICE OF THE SECRETARY OF STATE VETERANS ORGANIZATION SOLICITOR'S REGISTRATION STATEMENT _____New 1. _____Renewal (Please print or type. Use additional sheets of paper if necessary) Name of solicitor:________________________________________________________________ Type of organization: (Corporation, unincorporated entity, partnership, etc.) ____________ _______________________________________________________________________________ Mailing Address: _______________________________________________________________ Telephone Number: (__________) __________________________ 2. Give the name, address, and telephone number of each veterans organization on whose behalf you solicit or will solicit. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 3. List all the other states in which you are registered as a solicitor and the status of those registrations. _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 4. 5. Number of counties in which you solicit. _________________________ Have you, as a solicitor, ever forfeited a bond under this Act? ____________________ If so, how many? _____________________________ What was (were) the date(s) of forfeiture? _________________________________________________________________ Executed this ______________ day of ___________________________, ___________. ___________________________________ ______________________________________ (Signature) (Printed or Typed Name & Title) American LegalNet, Inc. www.FormsWorkFlow.com Form #3504 INFORMATION AND INSTRUCTIONS Return the registration/renewal form and the filing fee of $500 along with the surety bond to: SECRETARY OF STATE Registrations Unit P. O. Box 13550 Austin, TX 78711-3550 For delivery: James Earl Rudder Office Building 1019 Brazos, 5th Floor Austin, Texas 78701 PLEASE NOTE - IF YOU RAISE MORE THAN $5,000 FOR A VETERANS ORGANIZATION DURING A CALENDAR QUARTER, YOU MUST FILE A REPORT WITH THE SECRETARY OF STATE AT THE END OF THAT CALENDAR QUARTER. FORMS FOR SUCH REPORTS CAN BE OBTAINED FROM THE ABOVE ADDRESS. American LegalNet, Inc. www.FormsWorkFlow.com