Chapter 202, Wis. Stats.          STATE OF WISCONSIN                         Division of Corporate and 
                            Subchapter II                                                                Consumer Services,  
                                                              Department of Financial Institutions       Charities Section 

                                                                                                         Mailing Address: 
                                E-Mail:                                                                  PO Box 7879 
                          DFICharitableOrgs@dfi.wisconsin.gov 
                                                                                                         Madison, WI 53707-7879 

                            Telephone: (608) 267-1711         WEBSITE:  DFI.WI.GOV 
                                                              CHARITABLE ORGANIZATION                    Courier Address: 
   Please - Do Not Staple                                                                                4822 Madison Yards Way 
                            Fax: (608) 267-6813               APPLICATION                                North Tower 
                                                                                                         Madison, WI 53705 

                          GENERAL REQUIREMENTS: 
                          If you are an organization based in Wisconsin, it is required that you complete this Application 
                          Form #296 if you: 
                          - Solicit or receive $25,000 or more charitable contributions in a single year.
                            AND/OR
                          - Have any paid employees at your organization.

                          If you are an organization based outside of Wisconsin, it is required that you complete this Application 
                          Form #296 if you: 
                          - Solicit or receive ANY charitable contributions in Wisconsin.

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: 

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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: 

5. Provide the following information for the person(s) who has custody of the applicant’s financial records.  Attach additional
   pages if necessary.

   First Name:                               Last Name:                                 Title: 

   Street:                                                                  City: 

   State:      Zip:               Telephone Number:                   E-mail:

6. Provide the following information for the person to whom we can ask questions about this application and other registration
   related matters:

   First Name:                               Last Name:                                 Title: 

   Street:                                                                  City: 

   State:      Zip:               Telephone Number:                   E-mail:

7. Provide the applicant’s website address, if any:

8. Indicate the type of organization with an “X.”

            Corporation                              Partnership 

           Limited Liability Company                 Sole Proprietorship 

           Limited Partnership                       Other (Please Specify) 

9. If the applicant is a corporation, a limited liability company, or
   a limited partnership, provide the applicant’s Federal Employer 
   Identification Number:
                          
   If the applicant is a sole proprietorship or a general partnership,
   provide each owner’s Social Security Number:

   Note: Pursuant to Sections  202.021(4)(a)5.-7.,  Wis. Stats., this Department is required to obtain this information from all 
   applicants.  The information will be shared with other state agencies for the purpose of matching against tax information and 
   outstanding child and family support data.

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10. Identify the month and day of the applicant’s fiscal year-end:

11. Provide the date and state of incorporation/organization.    Date:                  State: 

QUESTIONNAIRE 

12. Is the applicant tax exempt?                                                                            Yes      No 

If the applicant is not tax exempt, has the applicant filed an Application for Recognition of              Yes       No 
Exemption (IRS Form #1023) with the IRS?

13. Did the applicant solicit contributions or conduct fundraising in Wisconsin during its most recently   Yes       No 
completed fiscal year?

a. If you answered “yes” and your organization is based in Wisconsin, identify the amount
   of       contributions received during the most recently completed fiscal year.

b. If you answered “yes” and your organization is based outside of Wisconsin, identify the
   amount of Wisconsin contributions received during the most recently completed
   fiscal year.

c. If you answered “yes” and your organization is based outside of Wisconsin, identify the
   amount of all contributions (Wisconsin and non-Wisconsin) received during the most
   recently completed fiscal year.

14. Did the applicant solicit contributions or conduct fundraising in Wisconsin during the current         Yes       No 
fiscal year?

If yes, what was the amount of Wisconsin contributions received?

15. Will the applicant use a professional fundraiser to solicit contributions in Wisconsin by mail,          Yes     No 
telephone, or any other means of communication?
If YES , provide the following information about the fundraiser(s).  Attach additional pages, if necessary.
Name of FundRaiser: 

Street:                                                                City: 

State:                            Zip:                                 Telephone Number: 

16. Will a fundraising counsel plan, manage, or advise the applicant with respect to solicitations in     Yes        No 
Wisconsin?
If YES , provide the following information about the fundraising counsel.  Attach additional pages, if necessary.
Name of FundRaising Counsel: 

Street:                                                                City: 

State:                            Zip:                                 Telephone Number: 

17. If the applicant will use a fundraising counsel, will the fundraising counsel, have custody of any     Yes       No   
contributions at any time?

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18. Has the applicant ever been the subject of disciplinary action including, but not limited to, civil
    forfeitures, cease and desist orders, injunctions, license/permit/registration suspensions, denials,
    revocations, warnings, reprimands, enforcement actions, probation and limitations by any                     Yes    No
    regulatory agency in Wisconsin or any other state?
    If YES, attach details about the disciplinary action, including but not limited to date, regulatory agency and type of discipline.

19. Is disciplinary action pending against the applicant in Wisconsin or any other state?                        Yes    No 
    If YES, attach details, including but not limited to action, regulatory agency, and state.

20. Has the applicant ever had a license, permit, registration, or other authority to solicit denied,            Yes    No 
    suspended or revoked by a court or are proceedings pending?
    If YES, attach a detailed statement of explanation and a copy of the court order.

21. Has the applicant ever been enjoined from soliciting contributions by a court or are such                    Yes    No 
    proceedings pending.
    If YES, attach a detailed statement of explanation and a copy of any court order issued.

22. Have any of the applicant’s officers, directors, trustees, or executive personnel (1) ever been              Yes    No 
    convicted of a felony at any time, (2) been convicted of a misdemeanor within the last 10 years,
    or (3) been charge with a felony or misdemeanor, and the charges remain pending?
    If YES, complete and attach a Convictions and Pending Charges form (Form 2252).

23. Identify the charitable purpose for which the applicant was organized.

24. Explain how the applicant will use the contributions it receives.

 CHECKLIST & ATTACHMENTS 

  Information you will need in order to complete Form #296: Please use this checklist prior to submitting Form #296 in 
  order to ensure  you have  ALL the materials necessary to be approved  as  a registered  Charitable  Organization in 
  Wisconsin. You may not become a  registered  Charitable Organization in Wisconsin until you submit a completed 
  application. 

    FEIN#______________ (#9)

    $15 Non-Refundable Fee is required. Checks can be made payable to WDFI.

    Your Fiscal Year End Date. (#10)

    Does your application address fundraising conducted or contributions received in Wisconsin during the most recently
     completed fiscal year, and during the current year? (#13 & #14) 

    If you answered yes to question #13 on Form #296, do the answers to #13 compare to the figures 990 (line 8)/or 1952 (line 1)? 
    If not, provide and explanation for the discrepancy in the amounts. 

    If you have used a professional fundraiser (PFR) or fundraising counsel (FRC), provide copy of all contracts used for
    Wisconsin PFR and/or FRC solicitation. (#’s 15-17) 

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     Has any disciplinary action been previously taken against your organization by another state? (#18) 

     Statement explaining how contributions received will be used. (#24) 

     All blanks on the application are filled in. 

     Application must be signed by 2 different officers (one must be CFO/treasurer). (pg. 6) 

     List of officers/directors, title, and address for each officer/director. (Met if provided on your IRS 990 pg. 7) 

     List of persons with final custody of contributions. 

     List of persons responsible for final distribution of contributions. 

     List of states where you currently have a Charitable Organization license (Met if provided on your IRS 990 pg. 6, 
    Section C #17 or EZ pg. 3) 

     Form #2252 or similar for officers/exec. personnel convicted of a misd./felony/pending charges. (#22) 

     Explanation statement for any denied/revoked registrations or pending proceedings. (#20)

     Explanation statement if ever enjoined from soliciting contributions or any pending proceedings. (#21) 

     Certificate of Incorporation (Non-Wisconsin Corporations only) – must include any name change amendments. 

            Your name on the application matches name on Certificate of Incorporation.

     Charter/Articles of Incorporation/Agreement of Association/Instrument of Trust/other organizational instrument 

     Your organization’s Bylaws (unless organized as a trust) 

     Certificate of Good Standing (Non-Wisconsin Corporations only) 

     IRS Determination Letter regarding approval of 501(c)3 status if you are tax exempt. A state approval letter is also acceptable. 

            Provide IRS Form 1023 or 1023EZ if 501(c)3 status is pending

     Financial Report– needed if your organization solicited/conducted fundraising during most recently completed fiscal year. 
     Form 1943 – used if you received contributions less than $50,000 in one community (county of CO’s residence) 
     or less than $25,000 in total.  As set forth in s. 202.12(6m)(e), Wis. Stats.  

                           All blanks filled in.  
                           One or both boxes in Affidavit section are checked. 
                           County where you solicit is identified. 
                           Affidavit 1 and/or Affidavit 2 is signed by Pres and CF O
                 OR
        Form 308 or Form 1952 – used if you received Contributions greater than $25,000 and didn’t qualify for the above 
        exemption. submit one of the following: Form 308 (only pages 4-6) if you don’t have an IRS 990 OR the most 
        commonly usedForm 1952 (only page 3)       if you have an IRS #990/990Z/990PF (990N is not acceptable). 
                           Financial information adds up.  
                           Amounts on Form 1952 match amounts disclosed on IRS Form 990. 
                           The expenses disclosed in column A of form 308 have been broken down into columns b, c, and d. 
                           Net income + beginning of the year net worth=end of year net worth.  If it doesn’t equal, 
                           please explain why. 

     CRED296 (Revised March 2024)                                                                        Page  5of  6

If Applicable:

    Audited financial statements if $1,0      00,000 or more in contributions during previously completed fiscal year
OR
       Reviewed financial statements if between $500,000-$ 99,9999 in contributions during previously completed fiscal year.
(Note: this amount should include the net proceeds from fundraising events, plus contributions received.)   

                          Audit/Review prepared according to the Generally Accepted Accounting Principles-GAAP 
                          Audit/Review is prepared by an independent firm. 
                          Net assets in Audit/Review match net assets on Form 1952 or Form 308 (unless Audit/Review 
                          is consolidated amongst multiple entities) 

CERTIFICATION 

Have two different officers sign the following certification.  One of the officers must be the chief fiscal officer.  

We certify that the information furnished in this application and in attachments to this application are true and correct to the best 
of our knowledge.    

_______________________________________________                __________________________________________________ 
Signature of President or Authorized Officer              Date Signature of Chief Fiscal Officer                                       Date 

RETURN APPLICATION MATERIALS TO: 
Department of Financial Institutions 
Division of Corporate and Consumer Services 
Mailing Address:                                               Street Address:   
PO Box 7879                                                    4822 Madison Yards Way North Tower 
Madison, Wisconsin 53707-7879                                  Madison, Wisconsin 53705 

This form is required under Section 202.12, Wisconsin Statutes.  Refusal to provide this information may result in the denial of this registration 
application.  Personally identifiable information on this form may be matched against tax information, outstanding child and family support data 
and law enforcement agencies.  Failure to complete this application completely and accurately may result in denial or revocation of registration, 
and any other penalties as provided by law.   

This document can be made available in alternate formats upon request to qualifying individuals with disabilities. 

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