Open to Public Inspection

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Conrad Farmer
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1 ac For new registrants only (Amending use CHAR410-A. Re-registcring use CHAR410-R) Registration Statement for Charitable Organizations New York State Department of Law (Office of the Attorney General) Charities Bureau - Registration Section 120 Broadway New York, NY Open to Public Inspection Part A - Identification of Registrant 1. Full name of organization (exactly as it appea rs in your organizing document) 5. Fed. employer ID no. (EIN) The Cordoba Initiative c/o Name ( if applicable) S. Organization's website 3. Mailing address ( Number and street) Room/suite 7. Prima ry contact 475 Riverside Drive 248 Courtney Erwin City or town, state or country and ZIP+4 Title Chief of Staff; Corporate Secretary Principal NYS address (Number and street) Room/suite Phone Fax Same as Above x City or town, state or country and ZIP+4 ce cordobainitiative.org Part B - Certification - Two Signatures Required We certify under penalties for perjury that we reviewed this Registration Statement, including all schedules and a tt achments, and to the best of our knowledge and belief, they are true, correct and complete in dan with the laws of the State of New York applicable to this statement. ~-.~ Imam Feisal Abdul Rauf President ~p /~ ~ 1 1. President or Autho rized OfficeNfrustee 2. Chief Financial Officer or Treasurer Sinnature 11-1% Printed Name Title ate Imam Feisal Abdul Rauf Treasurer Printed Name Title Date Part C - Fee Submitt ed If registering to solicit contributions, fee is $25. If not registe ring to solicit contributions, no fee is owed. Check ~ if you are submitting $25 fee to register to solicit contributions. Submit check or money order, payable to "NYS Department of Law." Part D - Attachments - All Documents Required Attach all of the following documents to this Registration Statement, even if you are claiming an exemption from registration: Certificate of incorporation, trust agreement or other organizing document, and any amendments; and Bylaws or other organizational rules, and any amendments; and IRS Form 1023 or 1024 Application for Recognition of Exemption (if applicable); and - IRS tax exemption determination letter (if applicable) Part E - Request for Registration Exemption Is the organization requesting exemption from registration under either or both Article 7-A or the EPTL? Yes' No * If "Yes", complete Schedule E. Page 1 of 3 Form CHAR410 (2004)

2 .4.r Part F - Organization Structure 1. Incorporation / formation a. Type of organization: Corporation... Limited liability company (LLC) Pa rtnership Sole proprietorship Trust... Unincorporated association Other'... * if Other, describe: b. Type of corporation if New York not-for-profd corporation A B11 C11 D0 c. Date incorporated if a corporation or formed if other than a corporation 0 5 f 2 6 I d. State in which incorporated or formed Colorado 2. List all chapters, branches and affiliates of your organization ( att ach additional sheets if necessa ry) Name Relationship Mailing address (number and street, room/suite, City or town, state or country and zip+4) The Corboda Initiative, Kuala Lumpur, Malaysia Branch 23-6, 3 Kia Peng; Jalan Kia Peng Kuala Lumpur, Malaysia 3. List all officers, directors, trustees and key employees Name Title Director;Chair I mam Fei sal Abdul Rauf o f Board President; Trea Mailing address (number and street, ro om/suite, city or town, state or count ry and zip+4) 475 Riverside Drive Suite urer 475 Riverside Drive Suite 248 Daisy Khan Director --- End of term (if applicable) 02/ /23/2011 John Bennett John Kiser Director Director 2211 E. Sopris Creek Rd.PO Box Aspen, CO Pophams Ford Road /23I2011 Sperryville, VA Courtney Erwin Chief of Staff; 475 Riverside Drive Suite 248 Not ApA lica Secretary / / ---- / I --- / / 4. Other Names and Registration Numbers a. List all other names used by your organization, including any pri or names Not Applicable b. List all prior New York State charities registration numbers for the organization, including those from the New York State Attorney General's Chari ti es Bureau or the New York State Depa rt ment of State's Office of Charities Registration Not Applicable Page 2 of 3 Form CHAR410 (2004)

3 4.. Pa rt G - Organization Activities 1. Month the annual accounting period ends ( 01-12) 2. NTEE code T Date organization began doing each of following in New York State: a. conducting activity / / b. maintaining assets / c. soliciting cont ri butions ( including from residents, foundations, corporations, government agencies, etc.) _ Not j ''ppli - F able 4. Describe the purposes of your organization Please see attached sheet 5. Has your organization or any of your officers, directors, trustees or key employees been: a. enjoined or otherwise prohibited by a government agency or cou rt from soliciting contributions? Yes' No * If "Yes", describe: b. found to have engaged in unlawful practices in connection with the solicitation or administration of charitable assets?... Yes' No * If "Yes", describe: 6. Has your organization's registration or license been suspended by any government agency? Yes* No * If "Yes", describe: 7. Does your organization solicit or intend to solicit contri butions (including from residents, foundations, corporations, government agencies, etc.) in New York State? Yes' No ' If "Yes", describe the purposes for which contributions are or will be solicited: Please see attached sheet. 8. List all fund raising professionals (FRP) that your organization has engaged for fund raising activity in NY State (a ttach additional sheets if necessa ry) Not Applicable Type of FRP Mailing address (number and street, ro om/suite, Name (see instructions for definitions) city or town, state or country and zip+4) Dates of contract PFR... FRC... CCV Sta rt date: End date: _ ---- PFR... FRC... ccv... PFR... FRC CCV... Sta rt date: End date: / Sta rt date: / / _ End date: / Part H - Federal Tax Exempt Status 1. If applicable, list the date your organization: a. applied for tax exempt status /- / b. was granted tax exempt status / 23 / 2004 c. was denied tax exempt status Not/Appl~cable - d. had its tax exempt status revoked Not /App1}cable - 2. Provide Internal Revenue Code provision: 501(c)( 3) Page 3 of3 Form CHAR410 (2004)

4 FORM CHAR410 REGISTRATION STATEMENT FOR CHARITABLE ORGANIZATIONS NEW YORK STATE DEPARTMENT OF LAW (OFFICE OF THE ATTORNEY GENERAL) CHARITIES BUREAU REGISTRATION SECTION 120 BROADWAY NEW YORK, NY SUPPLEMENTAL SHEET ACCOMPANYING THE FORM CHAR410 SUBMITTED BY THE CORDOBA INITIATIVE PART F, QUESTION 1(b) Although not a New York corporation, we make note that the Cordoba Initiative has been granted an Application for Authority as a Type B Not-for-Profit Corporation by the New York Secretary of State. PART G, QUESTION 4- Describe the Purposes of you Organization. The Cordoba Initiative is a not-for profit corporation with 501(c)(3) designation. Its purpose is to improve the relationship between the United States and the Muslim world by promoting policy research, dialogue, media, social, cultural, religious, and informational programs. PART G, QUESTION 7- Describe the Purposes for which contributions will be solicited. 1) organizing meetings, conferences, colloquia, trainings, and other meetings of groups of -- among others -- young Muslim leaders, members of the media, academics, government officials, community representatives and activists, and religious officials to discuss and collaborate on ways to improve relations between various groups in the Muslim and Western worlds; 2) engaging with media (print, television, radio, film); 3) developing Cordoba's existing and future programmatic portfolio (including, but not limited to, religious interpretation and governance, media, gender equality, policy and government affairs, and youth empowerment), and 4) fund raising. 9. List all corporation directors and officers (attach list if needed) Imam Feisal Abdul Rauf- Director, Chairman of the Board, President and Treasurer c/o The Cordoba Initiative 475 Riverside Drive Suite 248 1

5 Daisy Khan - Director c/o The Cordoba Initiative 475 Riverside Drive Suite 248 John Bennett - Director 2211 East Sopris Creek Drive Aspen, CO John Kiser - Director 210 Pophams Ford Road Sperryville, VA Courtney Erwin - Secretary c/o The Cordoba Initiative 475 Riverside Drive Suite 248 2

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Number and street (or P.O. box if mail is not delivered to street address) Room/suite f. Telephone number

Number and street (or P.O. box if mail is not delivered to street address) Room/suite f. Telephone number Form CHAR500-C This form used for combined filings by parent Article 7-A and dual filer and its affiliates (replaces form CHAR 497-C) 1. General Information - Parent Organization Combined Annual Financial