TITLE 14: COMMERCE
SUBTITLE B: CONSUMER PROTECTION CHAPTER II: ATTORNEY GENERAL
PART 400
SOLICITATION FOR CHARITY ACT
SECTION 400.APPENDIX A CHARITABLE ORGANIZATION FORMS
Section 400.APPENDIX A
Charitable Organization Forms
Section 400.ILLUSTRATION B Financial
Information Form
Form CO-2
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CHARITABLE ORGANIZATION
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FINANCIAL INFORMATION FORM ─
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JIM RYAN
ATTORNEY GENERAL
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PLEASE TYPE OR PRINT IN INK. Organizations that have been in operation less than
one (1) year are required to complete this form, in compliance with the
"Charitable Organization Registration Statement" Form CO-1 Line 20,
and file each form with the Attorney General's Office, Charitable Trust and
Solicitations Bureau, 100 West Randolph Street, Chicago, Illinois 60601.
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1.
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Name,
address and telephone number of the organization:
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2.
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The
books and records are located at the following address and telephone number:
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3.
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Are
the gross receipts for the current calendar/fiscal year expected to exceed
$10,000.00?
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Yes
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No
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4.
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Please
provide the following financial information:
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From inception
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thru
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Month/Day/Year
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Month/Day/Year
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GROSS RECEIPTS TO DATE
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ASSETS
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Contributions, Gifts &
Grants
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$
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Cash
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$
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Program Service Revenue
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Accounts
Receivable
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Dues
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Other
Receivables
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Interest & Dividends
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Inventory
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Rents
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Investments
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Fund Raising Events
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Land,
Buildings, Equip.
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Other Revenue
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Other
Assets
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TOTAL
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$
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TOTAL
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$
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(IN LIEU OF THE ABOVE
FINANCIAL INFORMATION, A CURRENT TREASURERS REPORT MAY BE SUBSTITUTED, PROVIDED
THAT IT PROVIDES SUBSTANTIALLY THE SAME INFORMATION)
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CERTIFICATION
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NOTE:
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At least two different
persons, familiar with the financial affairs of the organization, are
required to sign. These parties should be the President and the Chief
Financial Officer, other authorized Officer or two Trustees.
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Name and Title
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Date
Signed
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Address
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Name and Title
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Date
Signed
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Address
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Subscribed
and sworn by me this
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day of
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,
19
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A.D.
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Notary
Public:
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(Source: Added at 24 Ill. Reg. 14684, effective September
21, 2000)
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