State of Wisconsin                                                 FILING FEE $3.00  

                 DEPARTMENT OF FINANCIAL INSTITUTIONS                Please check box to request   
                 Division of Corporate & Consumer Services                                            +   $25.00 
                                                                      Optional Expedited Service 
                   
 FORM 20               NEWLY ELECTED OFFICERS AND DIRECTORS 
                                 Sec. 180.0860(1),181.0860(1)  , or 185.31(3), Wis. Stats. 
                                                              
A. Name of the corporation or cooperative:                                                                        
 
B. Principal officers were elected, or changes made on                                               (Date).  
   Pursuant to such action, the principal officers are:  (Append schedule if space is insufficient) 
 
 TITLE           NAME                                       BUSINESS ADDRESS (Complete mailing address) 
 President/                                                  
  
 Vice President/                                             
  
 Secretary/                                                  
  
 Treasurer/                                                  
  
C. Directors were elected, or changes made on                                                       (Date).  
   Pursuant to such action, the directors are:  (Append schedule if space is insufficient) 
 
 TITLE           NAME                                       BUSINESS ADDRESS (Complete mailing address) 
 Director                                                    
  
 Director                                                    
  
 Director                                                    
  
 Director                                                    
  
 Director                                                    
  
D.  Executed on                                                                                        
                         (Date)                                                 (Signature) 
                      
Title:     President     Secretary     
or other title                                                                                         
                                                                              (Printed name) 
 
DFI/CORP/20 (R12/22)                                                                                          1 

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 isnot 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.) 

DFI/CORP/20 (R12/22)                                                                                                  2