VA Office of Charitable and Regulatory Programs Form 102 Annual Renewal, Signature Page, 2022 March 29

REGISTRATION STATEMENT FOR A CHARITABLE ORGANIZATION Revised 11/21
Form 102, Page 6

26. OATH OR AFFIRMATION. (MUST BE WET INK SIGNATURES)

*Two (2) different officers must sign this registration form. The original signature page (page 6) must then be filed
with the Office of Charitable and Regulatory Programs. Copies are not allowed.

We, the undersigned chief fiscal officer (chief financial officer, or treasurer) and president (or other
authorized officer, if presi is ilable to sign), duly authorized to act on behalf of the organization
for which this statement is made, certify that this and including an)

have been examined by us and are, to the best of our knowledge and belief, true, correct and complete
pursuant to the laws of the Commonwealth of Virginia.

We affirm and attest that no funds have been or will knowingly be used, directly or indirectly, to benefit or
provide support, in cash or in kind, to terrorists, terrorist i terrorist activities, or the family
members of any terrorist. We understand that no person shall be registered by the Commonwealth or by any
locality to solicit funds that are intended to benefit or support a family member of any terrorist.

Af, 4 Melk?

Wet ink signature of the chief fiscal/officer, chief Wet ink signature of the president or other
financial officer, or treasurer authorized officer
Adam L. Northup Michael E. Stone
Print name Print name
Treasurer Administrator
Title Title
/ /
4/Z2¢/Lor
Date 7 7 Date

*The persons signing this form as chief fiscal officer (chief financial officer/treasurer) and president (or other authorized
officer) must be designated by title on the current fiscal year’s list of officers, directors, trustees, and principal salaried
executive staff (see §57-49.D. of the Code of Virginia).

Section 57-61.1.A. of the Code of Virginia states that "Registrations by charitable organizations, professional
solicitors, and professional fund-raising counsel are effective, if complete, upon receipt by the Commissioner.”
For more information on determining whether your registration is complete, see:

http://www.vdacs.virginia.gov/consumer/pdf/oca-102registration.pdf.

Rules Governing the Solicitation of Contributi http:/www.vdacs.virginia.gov/forms-
pdf/cp/oca/charitable/ocasolicitationreg.pdf.