TITLE 14: COMMERCE
SUBTITLE B: CONSUMER PROTECTION CHAPTER II: ATTORNEY GENERAL
PART 480
CHARITABLE TRUST ACT
SECTION 480.EXHIBIT B FINANCIAL INFORMATION FORM
Section 480.EXHIBIT B Financial
Information Form
FORM CO-2
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CHARITABLE
ORGANIZATION
- 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
$10,000.00?
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Yes
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No
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4
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Please
provide the following financial information:
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From
inception
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thru
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Month/Day/Year
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Month/Day/Year
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GROSS RECEIPTS TO DATE
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ASSETS
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Combinations, Gifts &
Grants
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$
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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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Date
Signed
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Name and Title
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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. 14665, effective September 1, 2000)
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