Form 1943 - Affidavit In Lieu Of Annual Financial Report Page 2
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47. 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.
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/1943 (R 4/2014)
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Parent category: Business