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STATE OF CALIFORNIA CT-NRP-1 Rev. 05/2011 DEPARTMENT OF JUSTICE APPLICATION FOR REGISTRATION PAGE 1 of 1 NONPROFIT RAFFLE PROGRAM California Penal Code section 320. All other information provided on this application is true and correct. Signature of Fiduciary Authorized Officer or Director Who Prepared This Form Printed Name of Fiduciary Authorized Officer or Director ct-NRP-1 5/2002 Date Title of Fiduciary Authorized Officer or Director. 5 The registration period is September 1 to August 31. After August 31 a new registration is required* A CHECK IN THE AMOUNT OF 20 MADE PAYABLE TO REGISTRATION FORM If you do not receive a decision on this application within 30 days from the time it is received by the Department of Justice you may apply to the Attorney General for a refund of the fee. See Cal* Code of Regulations Title 11 section 419. 1 STREET ADDRESS 1300 I Street Sacramento CA 95814 Telephone 916 445-2021 WEBSITE ADDRESS http //www. ag. ca*gov/charities/ For Registry Use Only Proof of California Franchise Tax Board exempt status must be attached to this registration application* This application will otherwise be deemed deficient and returned to the organization* Name of Organization MAIL TO Office of the Attorney General Registry of Charitable Trusts P. O. Box 903447 Raffle Registration Number Provide at least one of the following Address of Organization Federal Tax Employer Identification Number/Employer Identification Number FEIN City or Town State and ZIP Code E-mail Address Corporate Number PROPOSED Telephone Number Fax Number Organization Number Charitable Trust Number State Charity Registration Number Specify the organization s tax - exempt status pursuant to California Revenue and Taxation Code section 23701a Labor agricultural or horticultural organizations 23701g Nonprofit pleasure and recreation clubs 23701b Fraternal beneficiary societies orders or associations 23701k Religious or apostolic corporations having common or literary educational amateur sports or prevention of cruelty to children or animals organization 23701l Domestic fraternal societies orders or associations 23701e Business leagues chambers of commerce real estate boards and boards of trade 23701t Homeowners and associations 23701f Civic leagues social welfare organizations and local employee organizations 23701w Veterans organizations Proposed date s of raffle s REQUIRED Required for application approval month/day/year By signing this application for registration I hereby certify that the organization named herein as the applicant is all of the following Applicant is a private nonprofit organization and 2. Applicant has been qualified to conduct business in the State of California for at least one year prior to the raffle first held and that 3. 5 The registration period is September 1 to August 31. After August 31 a new registration is required* A CHECK IN THE AMOUNT OF 20 MADE PAYABLE TO REGISTRATION FORM If you do not receive a decision on this application within 30 days from the time it is received by the Department of Justice you may apply to the Attorney General for a refund of the fee. See Cal* Code of Regulations Title 11 section 419. 1 STREET ADDRESS 1300 I Street Sacramento CA 95814 Telephone 916 445-2021 WEBSITE ADDRESS http //www..

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