Fill and Sign the Annual Report Organization Form

STATE OF WISCONSIN, CIRCUIT COURT For Official Use Annual Report of Crime Prevention Organization (Law Enforcement Agency) TO: THE CLERK OF COURTS FOR       COUNTY FROM: Name of law enforcement agency       Address       Name of crime prevention fund       Note: A crime prevention organization is defined in §973.06(1)(f)1.b., Wisconsin Statutes as “A law enforcement agency that has a crime prevention fund, if the contribution is credited to the crime prevention fund and is used for crime prevention purposes” (emphasis added). A copy of the fund’s purpose, mission statement or other documentation setting forth a purpose consistent with the statutory definition must be attached to this report. RE: Annual report of contributions received and expenditures made required pursuant to, §757.17, Wisconsin Statutes for the calendar year 2     . 1. The officers of this crime prevention fund are: NAME OF OFFICER OFFICE HELD                                                                                                 (Attach additional list if more officers.) 2. During the reporting period, contributions in the total amount of $       were made to the organization as set forth in Schedule A, attached. (Attach as many sheets as necessary.) 3. During the reporting period, expenditures in the total amount of $       were made by the organization as set forth in Schedule B attached. (Attach as many sheets as necessary.) CR-242, 12/01 Annual Report of Crime Prevention Organization (Law Enforcement Agency) §757.17, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page ___ of ___ Annual Report of Crime Prevention Organization (Law Enforcement Agency) Page ___ of ___ 4. The purposes for which these crime prevention fund expenditures were used and an explanation as to how they conform to the statutory definition as set forth above are: (Attach additional pages as needed.)       5. The amount of contributions remaining in the crime prevention fund from the prior calendar year were $       . 6. The amount of contributions remaining in the crime prevention fund as of the closing date of this report is $       . 7. I certify that I have prepared this report and that the information included in the report is complete and accurate. The records on which the report is based may be viewed at:       during office hours. Name of preparer       Daytime telephone number       Address       Signature of preparer Date       CR-242, 12/01 Annual Report of Crime Prevention Organization (Law Enforcement Agency) §757.17, Wisconsin Statutes . This form shall not be modified. It may be supplemented with additional material. Page ___ of ___ Schedule A Name of Contributor/Defendant Branch Number of Court Requiring Contribution Amount Schedule B Name of Recipient of Expenditure Amount of Expenditure