Charitable organizations exempt from registration

(a) Every charitable organization claiming an exemption from registration pursuant to section 21a-190d of the Connecticut General Statutes, shall substantiate the basis for the exemption by filing a form furnished by the department which states: (1) Whether the organization has ever been registered under the provisions of Chapter 419d of the Connecticut General Statutes and, if the organization has been registered, its registration number; (2) the organization's full legal name and mailing address; (3) the organization's telephone and facsimile numbers; (4) any name or names under which funds will be solicited other than the name given in subdivision (2) of subsection (a) of this section; (5) whether the organization is incorporated and, if so, the state of incorporation; and (6) the statutory basis for the exemption, and if the basis is section 21a-190d(6) of the Connecticut General Statutes (amount of contributions is less than the statutory threshold), a statement of its charitable purpose and major program activities. (b) The form shall be signed under penalty of false statement by two authorized officers of the organization. (c) For purposes of section 21a-190d(6) of the Connecticut General Statutes, "normally" means any two out of the charitable organization's most recently completed three fiscal years.