Form PFR-02
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PROFESSIONAL
FUND RAISER ANNUAL FINANCIAL REPORT
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JIM RYAN
ATTORNEY GENERAL
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THIS MUST BE FILED BY
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FILE AT: Office of the
Attorney General, Charitable Trust and Solicitations Bureau, 100
West Randolph Street, Chicago, Illinois 60601
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GENERAL INSTRUCTIONS
(FURTHER INSTRUCTIONS AT END OF FORM)
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PLEASE TYPE OR PRINT IN BLACK INK
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A.
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RESPOND TO ALL ITEMS ON THIS
FORM.
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B.
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CHANGES OF OR ADDITIONS TO
THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT.
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C.
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ANNUAL REPORT (CHECK ONE):
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PREPARED ON ACCRUAL BASIS
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PREPARED ON A CASH BASIS
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OR PREPARED BY ANOTHER
METHOD
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IF PREPARED BY ANOTHER
METHOD EXPLAIN:
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LEGAL NAME
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REGISTERED
FOR FISCAL YEAR
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MAIL ADDRESS
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ENDED
JUNE 30,
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AS
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CITY
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PFR#
02-
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STATE, ZIP CODE
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FEDERAL
ID NUMBER
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PHONE NUMBER
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( )
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REPORT IS FOR PERIOD
BEGINNING JANUARY 1,
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AND ENDING
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CHARITIES FOR WHOM FUNDS
WERE RAISED
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(A)
AMOUNT TO
CHARITY
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(B)
SOLICITATION
EXPENSES
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(C))
TOTAL AMOUNT RAISED
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(D)
% = A/C
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TOTAL FOR ALL CHARITABLE
FUNDRAISING BY PFR:
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TOTAL NUMBER OF CHARITIES
BEING REPORTED
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Note: Verification must be
by the Corporate President, a General Partner or the Sole Proprietor
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STATE OF
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}
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SS
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AFFIDAVIT
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COUNTY OF
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I,
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,
under penalty of perjury and being sworn on oath that I am (circle one) the
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corporate president, a
general partner or the sole proprietor of the registered professional
fundraiser.
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(Name of
PFR)________________________________
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,
have read this annual report including all attachments and personally
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know the contents thereof to
be true, and such is stated herein and filed with the Illinois Attorney
General for the purpose of having the people of the State of Illinois rely thereupon. I hereby further authorize and agree to submit myself and the
registrant hereby to be jurisdiction of the State of Illinois.
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Subscribed and sworn to
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before me, this
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(Signature)
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day of
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19
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NOTARY PUBLIC
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(Source: Added at 24 Ill.
Reg. 14684, effective September
21, 2000)