Form
     CU                                            Wisconsin
Wisconsin Department  Credit Union Declaration of Exempt Status                                                   2024
of Revenue
 Name of Credit Union

 Number and Street

Ste Number       City                     State    Zip Code (+ 4 digit suffix if known) For Income Year Year of Incorporation

Federal Employer I.D. Number             Wis. Employer I.D. (Withholding) Number        Seller’s Permit or Use Tax Number

                                         Form CU Instructions

Purpose of Form CU                                           When to File

Credit unions which are exempt from the Wisconsin            Form CU must be filed on or before April 15 of the 
franchise or income tax under the provisions of Ch.          year following the income year for which the return 
71, Wis. Stats., should file Form CU instead of filing       is filed.
a Wisconsin corporation franchise or income tax 
return, Form 4 or 6.  Thereafter, the credit union           Where to File
need not file a corporation tax return (Form 4 or 
6) or  Form  CU  for  any  subsequent  year  unless          Mail  Form  CU  to  the  Wisconsin  Department  of 
requested to do so by the Department of Revenue              Revenue, PO Box 8908, Madison, WI 53708-8908.
or unless in a subsequent year the credit union
acts as a public depository. Use Schedule CU-1 to
report public deposits.

Note:  Credit unions that do not derive income from 
public deposits are exempt from the Wisconsin tax 
on unrelated business taxable income, as computed 
under section 512 of the Internal Revenue Code.

                Applicable Laws and Rules

This document provides statements or interpretations 
of the following provisions of Wisconsin Statutes in 
effect as of the revision date: chs. 71, Wis. Stats. and 
chs. Tax 1, 2 and 3 Wis. Adm. Code.

I, the undersigned authorized officer of the credit union for which this declaration of exempt status is made, declare that the above 
named credit union had no deposits of public funds during the income year shown above and I understand that a Wisconsin franchise 
or income tax return must be filed for any future year for which the credit union’s deposits include public funds.
Signature                                              Title                                            Date

IC-081 (R. 8-24)