Form 296 - Charitable Organization Application And Registration Statement
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STATE OF WISCONSIN
Chapter 202, Wis. Stats.
Division of Banking
Subchapter II
Department of Financial Institutions
Mailing Address:
PO Box 7876
Telephone: (608) 267-1711
Madison, WI 53707-7876
Fax: (608) 267-6889
Courier Address:
201 W. Washington Ave.
Suite 500
CHARITABLE ORGANIZATION
Madison, WI 53703
APPLICATION &
REGISTRATION STATEMENT
Purpose: A completed Charitable Organization Application & Registration Statement should be submitted to the Department of
Financial Institutions (“department”) for consideration of registration. Upon the filing of such application, the department shall
investigate the relevant facts to determine if the applicant satisfies all of the eligibility requirements for charitable organization
registration. If the department finds that the applicant meets all of the requirements, the department shall register the applicant as a
charitable organization.
Print or type the information requested in the spaces provided.
APPLICANT INFORMATION
1.
Name of applicant: The “applicant” is the corporation, limited liability company, limited partnership, partnership, or sole
proprietorship that is registering with the department. If the applicant uses any trade names or DBA (doing business as)
names for soliciting, include those names as well.
2.
Provide the following information for the applicant’s headquarters office, if any:
Street Address:
City:
State:
Zip:
Telephone:
Fax:
E-Mail:
3.
Provide the applicant’s mailing address if different than above.
Street Address:
P.O. Box:
City:
State:
Zip:
4.
Provide the following information for each of the applicant’s Wisconsin offices, if any. Attach additional pages if necessary.
This item does not have to be completed if the headquarters office noted above is the only Wisconsin office.
Street Address:
Telephone:
City:
State:
Zip:
DFI/LFS/296 (R 3/2014)
CO APP & REGISTRATION STATEMENT
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Parent category: Financial