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Contact Information:
Name
Mailing Address
City State Zip Code
Email Address Phone Number
INSTRUCTIONS (Ref. ss. 180.0860(1),181.0860(1) , & 185.31(3), Wis. Stats. for document content)
Please use BLACK ink. Submit one original to State of WI-Dept. of Financial Institutions, Box 93348, Milwaukee WI,
53293-0348, together with a check for the $3.00 filing fee, payable to the department. Please check box, and include
additional $25.00, if requesting optional expedited service. Filing fee is non-refundable. (If sent by Express or Priority
U.S. mail, please mail to State of WI-Dept. of Financial Institutions, Division of Corporate and Consumer Services, 4822
Madison Yards Way, 4th Fl., North Tower, Madison WI, 53705.) This document can be made available in alternate
formats upon request to qualifying individuals with disabilities. Upon filing, the information in this document becomes
public and might be used for purposes other than those for which it was originally furnished. If you have any questions,
please contact the Division of Corporate & Consumer Services at 608-261-7577, hearing-impaired may call 711 for TTY,
or by email at DFICorporations@dfi.wisconsin.gov.
A. Enter the name of the corporation or cooperative. (Note: This statement is not appropriate for use by limited
partnerships, limited liability companies, or limited liability partnerships.)
B & C. Enter the date new officers and/or directors were elected or appointed. Provide the name and address of all the
principal officers and directors in office after giving effect to the elections or appointments.
D. Enter the date of execution and the name and title of the person signing the document.
Cooperative or Business Corporation: An officer of the entity must sign. A director is not empowered to sign.
Nonstock Corporation: An individual authorized by the entity to sign on its behalf must sign.
NOTE: Except as indicated below, the filing of this statement is optional. A corporation is not required to report
changes in its officers or directors apart from the filing of its annual report. It may submit this statement for the public
record to reflect changes occurring between the times it files its annual report.
Whenever there is a change in officers or directors of acooperative association, the association isobliged to report such
change to the Department of Financial Institutions within 20 days. (See ss. 185.31(3) and 185.35(1), Wis. Stats.)
Form Corp20 (Revised February 2023) Page 2 of 2
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