Fund-raising counsel registration statement

(a) Every fund-raising counsel that is required to register or renew its registration with the department pursuant to section 21a-190e(b) of the Connecticut General Statutes, shall provide the following information on a registration statement furnished by the department: (1) Whether the fund-raising counsel 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 fund-raising counsel's full legal name and mailing address; (3) the fund-raising counsel's telephone and facsimile numbers; (4) the names, residence addresses and titles of all officers, directors, and key employees of the fund-raising counsel; (5) whether the fund-raising counsel is a corporation, partnership, limited liability company, individual or other entity; (6) the year of the fund-raising counsel's organization and the state under the laws of which the fund-raising counsel was organized; and (7) whether the fund-raising counsel's registration has ever been revoked, denied, suspended or enjoined by any state agency or by any court, or whether any such proceedings are pending and, if any of the foregoing has occurred, a detailed explanation of the circumstances. (b) The registration statement shall be signed under penalty of false statement by an authorized officer of the fund-raising counsel. (c) A fund-raising counsel shall be considered as registered upon the receipt by the department of a fully completed original registration statement and the fee prescribed by section 21a-190e(b) of the Connecticut General Statutes.