6. Provide the following information for the organization’s Wisconsin office, if any. Attach additional pages, if the organization
has more than one Wisconsin office. This item does not have to be completed if the headquarters office noted on page 1 is the
only Wisconsin office.
Street:
City:
State:
Zip:
Daytime Phone Number:
7. Provide the following information for the person(s) who has custody of the organization’s financial records. Attach additional
pages, if necessary.
First Name:
Last Name:
Street:
City:
State:
Zip:
Daytime Phone Number:
8. Provide the following information for the person(s) within the charitable organization who has final responsibility for the
custody of contributions. Attach additional pages, if necessary.
First Name:
Last Name:
Street:
City:
State:
Zip:
Daytime Phone Number:
9. Provide the following information for the person(s) within the organization who is responsible for the final distribution of
contributions. Attach additional pages, if necessary.
First Name:
Last Name:
Street:
City:
State:
Zip:
Daytime Phone Number:
10. Provide the following information for the person to whom we can ask questions about this form and other registration related
matters.
First Name:
Last Name:
Phone:
E-mail:
Street:
City:
State:
Zip:
11. Describe the charitable purpose or purposes for which contributions will be used or attach a document which provides such
information. (You can disregard this item if you are attaching an IRS 990 that already includes this information.)
12. For solicitations in Wisconsin, did your organization use a professional fund-raiser or fund-raising
counsel or did your organization pay a person to solicit contributions, other than a salaried officer
or employee of your organization, during the previous fiscal year?
Yes
No
If YES, provide the following information about each fund-raiser(s), fund-raising counsel(s), or person.
Attach additional pages, if necessary.
Name:
Fund-Raiser:
Fund-Raising Counsel:
Street:
City:
State:
Zip:
Telephone Number:
Does the fund-raiser/fund-raising counsel/person have
custody of contributions
at any time:
Yes
No
CO WI SUPPLEMENT TO FINANCIAL REPORT
Page 2 of 5
DFI/LFS/1952 (R 3/2014)