Form 1943 - Affidavit In Lieu Of Annual Financial Report - Wisconsin Department Of Regulation & Licensing Page 2

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Wisconsin Department of Regulation & Licensing
YES NO
During the past year has your organization had its authority to solicit contributions denied,
suspended, revoked or enjoined by a court or other governmental authority? If YES, attach an
explanation.
Does your organization solicit contributions under any name other than the name of the
organization at the top of this form? If YES, list the other name or names here:
DESCRIBE THE CHARITABLE PURPOSE OR PURPOSES FOR WHICH CONTRIBUTIONS
WILL BE USED OR ATTACH A DOCUMENT WHICH PROVIDES SUCH INFORMATION.
Complete either affidavit Form 1 or Form 2 below, or both, if true of
your charitable organization’s operations and revenues.
FORM 1: AFFIDAVIT OF ORGANIZATION WITH CONTRIBUTIONS
LESS THAN $5,000
We swear that the organization identified on the other side of this form will not be submitting Form #308,
Charitable
Organization
Annual
Report,
for
its
most
recently-completed
fiscal
year,
ending __________________________________, _________, because contributions received during that
fiscal year did not exceed $5,000.
CERTIFICATION-TWO DIFFERENT SIGNATURES ARE REQUIRED BY LAW.
______________________________________________________
______________________________
(Signature of President)
(Date)
______________________________________________________
______________________________
SIGNATURE OF NOTARY PUBLIC
(Seal)
DATE COMMISSION EXPIRES
Subscribed and sworn before me this _____ day of ___________________________________, ____________.
______________________________________________________
______________________________
(Signature of Chief Fiscal Officer)
(Date)
______________________________________________________
______________________________
SIGNATURE OF NOTARY PUBLIC
(Seal)
DATE COMMISSION EXPIRES
Subscribed and sworn before me this _____ day of ___________________________________, ____________.
Page 2 of 4

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