Form CO-1                          CHARITABLE ORGANIZATION                                                         KWAME RAOUL 
Revised 1/19                            - REGISTRATION STATEMENT -                                             ATTORNEY GENERAL

   PLEASE TYPE OR PRINT IN INK.  This registration statement is required by the Illinois Charitable Trust Act and the Illinois 
   Solicitation for Charity Act.  Please answer all items which are applicable to your organization.  If you are unable to answer any 
   question fully in the space provided, please attach a sheet containing the remainder of your answer.  No further registration statement is 
   required, provided that every registered organization shall notify the Attorney General within 10 days of any change in the information 
   submitted herein.  One copy of this Registration Statement and attachments are to be filed with the Office of the Attorney General, 
   Charitable Trust Bureau, 100 West Randolph Street, 11th Floor, Chicago, Illinois  60601

1. This is a registration under: 9 Illinois Charitable Trust Act:
                                 9 Illinois Solicitation for Charity Act;
                                 9 Both Acts

2. Name of Organization                                                             Telephone Number              Federal Employer ID#

   _____________________________________________________________________________________________________________
   Street and Number               City                               County                State              Zip Code

   _____________________________________________________________________________________________________________

3. Type of legal entity (Corporation, Trust, Unincorporated Association or other) and date, method and place organization legally estab-             
   lished.   __________________________________________________________________________________________________
   If a foreign corporation, when was it authorized to do business in Illinois? __________________________________________________
   If a corporation, Illinois Secretary of State’s File No. ____________________
   *A copy of the Articles of Incorporation or Certificate of Authority issued by the Secretary of State must be attached.

4. Name, address and telephone number of Illinois registered agent    ________________________________________________________
   _____________________________________________________________________________________________________________

5. Address of all offices in the State of Illinois. _________________________________________________________________________
   _____________________________________________________________________________________________________________
   _____________________________________________________________________________________________________________

6. Date on which the annual accounting period of the organization ends.  Month __________________________    Day ____________

7. State the purposes of the organization and purposes for which contributions are to be used.  (Be specific)
   _____________________________________________________________________________________________________________
   _____________________________________________________________________________________________________________
   _____________________________________________________________________________________________________________
   _____________________________________________________________________________________________________________

8. If the name under which the organization intends to solicit funds differs from the name listed in No.2 provide name(s) under which
   contributions will be solicited, and the reason for the use of such other name(s). _____________________________________________
   _____________________________________________________________________________________________________________

9. If the organization has previously been registered with the Attorney General under either Act, give the name under which registered (if
   different than shown in No. 2), last registration number, and date registered.    ______________________________________________
   _____________________________________________________________________________________________________________

10. Has the organization been registered with any other governmental authority to solicit contributions? 9 Yes 9 No
   Name of authority and date of authorization. _________________________________________________________________________
   Is such registration current? 9 Yes  9 No

11. Has the organization or any of its officers, directors or trustees ever been enjoined or prohibited by any court or other governmental  agency
   from soliciting contributions, or is such action pending? 9 Yes 9 No
   If “Yes”, attach an explanation.

12. Do you intend to use the services of a professional fund raiser as defined by “An Act to Regulate Solicitation and Collection of Funds for
    Charitable Purposes”?            9 Yes       9 No
    If “Yes”, answer a, b, and comply with c below.
    a. Name and address of professional fund raiser(s): ___________________________________________________________________
    _____________________________________________________________________________________________________________
    b. Has the professional fund raiser registered and filed a bond with the Office of the Attorney General as required?  9 Yes         9 No
    c. Attach copies of all contracts with professional fund raiser(s).

13. Have any of organization’s officers, directors, executive personnel, or have any of the organization’s employees who have access to
    funds, ever been charged with or convicted of a misdemeanor involving misapplication or misuse of money of another, or any
    felony?    9 Yes      9No     If “Yes”, give the following information: (IRS 1981 ch.. 23, sec. 5109)
    NAME AND ADDRESS OF COURT                                 NATURE OF OFFENSE                            DATE OF CONVICTION(Mo./Yr.)
    _____________________________________________________________________________________________________________
    _____________________________________________________________________________________________________________

14. State the board, group or individual having final discretion as to the distribution and use of contributions received.
    _____________________________________________________________________________________________________________

15. Will you use any of the following methods of solicitation?              9 Unordered Merchandise      9 Distribution or Sale of Seals
    9 Telephone Appeals              9 Coin Collection Containers           9 Special Events        9 Ad Books 9 Direct Mail
    9 Other --- If other, attach an explanation.

16. List name, mailing address and title of the chief executive or staff officer of the organization. __________________________________
    _____________________________________________________________________________________________________________

17. Attach a list of names, mailing addresses, and daytime phone numbers of all officers and directors, or trustees of the organization.

18. Has the United States Internal Revenue Service determined that this organization is tax exempt?      9 Yes 9 No
    If “Yes”, attach a copy of the determination letter.  Is application pending?                        9 Yes 9 No
    *All organizations with tax exempt status or an application pending must attach a copy of
    Federal Form 1023 “Application for Recognition of Exemption” or an exemption letter.

19. Has organization’s tax exempt status ever been questioned, audited, denied or cancelled at any time by any governmental agency?
    9 Yes        9 No      If “Yes”, attach the facts.

20. Organizations which have been in operation for over one (1) year must attach a copy of the form AG990-IL and Federal return,
    or AG990IL if no Federal return was filed for each year the organization was in existence, completed in detail.  Organizations
    which have been in operation less than one (1) year must attach a completed Financial Information Form CO-2, notarized.  Please
    note charitable organization’s are required to maintain accurate and detailed accounting records.

21. Approximate amount of contributions solicited or income received from persons in this State during the organization’s last annual
    accounting period $ _____________________________

22. EVERY REGISTERING ORGANIZATION MUST ATTACH THE FOLLOWING APPLICABLE DOCUMENTS:
    Corporation....................................The Articles of Incorporation and/or Certificate of Authority, Amendments and By-Laws
    Unincorporated Association...........Constitution and By-Laws
    Testamentary Trust.........................Will, Probate number and Decree of Distribution
    Inter Vivos Trust.............................Instrument Creating Trust
Note: The President and the Chief Financial Officer or other authorized officer are both required to sign.  This must be two different
      individuals.  If entity is a Trust, all Trustees must sign.

UNDER PENALTY OF PERJURY, THE UNDERSIGNED DECLARE AND CERTIFY THAT THE INFORMATION CONTAINED 
IN THIS STATEMENT AND ALL ATTACHED SHEETS IS TRUE AND CORRECT TO THE BEST OF OUR KNOWLEDGE.

Signature______________________________________________________________Title__________________________________Date_________________________

Signature______________________________________________________________Title__________________________________Date_________________________