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                            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 CFO
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.

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    Audited financial statements if $500,000 or more in contributions during previously completed fiscal year, or  
     Reviewed financial statements if between $300,000-$499,999 in contributions. (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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