Form Co-1 - Charitable Organization Registration Statement, Form Co-2 - Charitable Organization Financial Information Form, Form Co-3 - Charitable Organization Religious Organization Exemption Form Page 3

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CHARITABLE ORGANIZATION
Form CO-2
LISA M ADIGAN
-
-
FINANCIAL INFORMATION FORM
Revised 2/15
ATTORNEY GENERAL
PLEASE TYPE OR PRINT IN INK. Organizations that have been in operation less than one (1) year are required to complete this form,
in compliance with the “Charitable Organization Registration Statement” Form CO-1 Line 20, and file each form with the Attorney
rd
General’s Office, Charitable Trust and Solicitations Bureau, 100 W est Randolph Street, 3 Floor, Chicago, Illinois 60601.
1. Name, address and telephone number of the organization: ______________________________________________________________
_____________________________________________________________________________________________________________
2. The books and records are located at the following address and telephone number: ___________________________________________
_____________________________________________________________________________________________________________
3. Are the gross receipts for the current calendar/fiscal year expected to exceed $10,000.00?
Yes
No
4. Please provide the following information:
From inception ____________________________ thru _____________________________
Month/Day/Year
Month/Day/Year
GROSS RECEIPTS TO DATE
ASSETS
Contributions, Gifts & Grants
$____________________
Cash
$____________________
Program Service Revenue
_____________________
Accounts Receivable
_____________________
Dues
_____________________
Other Receivables
_____________________
Interest & Dividends
_____________________
Inventory
_____________________
Rents
_____________________
Investments
_____________________
Fund Raising Events
_____________________
Land, Buildings, Equip. _____________________
Other Revenue
_____________________
Other Assets
_____________________
TOTAL
$
TOTAL
$
(IN LIEU OF THE ABOVE FINANCIAL INFORMATION, A CURRENT TREASURERS REPORT MAY BE SUBSTITUTED, PROVIDED THAT IT
PROVIDES SUBSTANTIALLY THE SAME INFORMATION)
CERTIFICATION
Note:
At least two different persons, familiar with the financial affairs of the organization, are required to sign. These parties should be the
President and the Chief Financial Officer, other authorized Officer or two Trustees.
Name and Title
Signature and Date Signed
______________________________________________________________________________
____________________________________________________
Address
______________________________________________________________________________
Name and Title
Signature and Date Signed
______________________________________________________________________________
____________________________________________________
Address
______________________________________________________________________________
Subscribed and sworn by me this ______ day of _______________, 20__ A.D.
Notary Public: ___________________________________________________

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