Fill and Sign the Wi Annual Report Form

STATE OF WISCONSIN, CIRCUIT COURT For Official Use Annual Report of Crime Prevention Organization (Private Non-Profit Organization) TO: THE CLERK OF COURTS FOR       COUNTY FROM: Name of crime prevention organization       Address       Employer I.D. number       Tax exempt number       Note: A crime prevention organization is defined in §973.06(1)(f)1.a., Wisconsin Statutes as “A private nonprofit organization which has as its primary purpose preventing crime, encouraging the public to report or assisting law enforcement in the apprehension of criminal offenders” (emphasis added). A copy of your organization’s Articles of Incorporation, By-laws or other institutional documentation setting forth a primary 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.) CR-243, 04/05 Annual Report of Crime Prevention Organization (Private Non-Profit Organization) §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 (Private Non-Profit Organization) Page ___ of ___ 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.) These expenditures meet the primary purposes of the crime prevention organization as set forth in the statutory definition because:       4. The amount of contributions remaining in the crime prevention fund from the prior calendar year were $       . 5. The amount of contributions remaining in the crime prevention fund as of the closing date of this report is $       . 6. I certify that I have prepared this report and that the information included in the report is complete and accurate. Name of preparer       Daytime telephone number       Address       Signature of preparer Date       CR-243, 04/05 Annual Report of Crime Prevention Organization (Private Non-Profit Organization) §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