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SECTION C: ATTACHMENTS
Choose the box next to the items that are attached to your annual report. Items A., B., and C. are required. Item D. or E. (or
Waiver Application of D. or E.) is required if the contributions received by your organization fall into the described ranges.
(Note: If you are submitting this form with your initial application, DO NOT submit attachments B. – E. Submit the attachments
cited in the application form instead.)
A. Schedules required by lines 8, 9c, 10, 11C, 12, 14, 15, 16, 34, 42, 46, 48, 49b, 55, 56, and 62.
R
E
Q B. List of all officers, directors, trustees, and principal salaried employees – The list must include each
U individual’s name, address, and title. Please note that “principal salaried employees” refers to the chief
I administrative officers of your organization, but does not include the heads of separate departments or smaller units
R within the organization.
E
D
C. A list of states that have issued a license, registration, permit, or other formal authorization to the
organization to solicit contributions.
C D. Audited Financial Statements if the organization received contributions in excess of $500,000 during its fiscal
H year. The financial statements must be prepared in accordance with generally accepted accounting principles and
E accompanied by the opinion of an independent certified public accountant.
C
K
Apply for Waiver of “D. Audited Financial Statements” if (1.) the organization’s contributions were, during
O
N each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which the waiver is being
E requested, the organization received one or more contributions from one contributor that exceeded $400,000.
I Include waiver form 1953.
F
A E. Reviewed Financial Statements if the organization received contributions in excess of $300,000, but not more
P than $500,000 during its fiscal year. The financial statements must be prepared by an independent certified public
P accountant. Audited financial statements are also acceptable.
L
I
C Apply for Waiver of “E. Reviewed Financial Statements” if (1.) the organization’s contributions were, during
A
B each of the past 3 fiscal years, less than $100,000; and (2.) during the fiscal year for which the waiver is being
L requested, the organization received one or more contributions from one contributor that exceeded $200,000.
E Include waiver form 1953.
SECTION D: CERTIFICATION
This document MUST be signed by the chief fiscal officer. Two different officer signatures required.
We certify that we have reviewed this report, including the accompanying schedules and statements, and to the best of our
knowledge the information furnished is true, correct, and complete.
_______________________________________ _____________________________________________
Signature of President or Authorized Officer Date Signature of Chief Fiscal Officer Date
RETURN MATERIALS TO:
Department of Financial Institutions Print Clear
Division of Corporate and Consumer Services
E-Mail: DFICharitableOrgs@dfi.wisconsin.gov
Mailing Address:
PO Box 7879
Madison, Wisconsin 53707-7879
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.
CRED308 (Revised June 2023) Page 7of 7
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