Form CO-2                                       CHARITABLE ORGANIZATION                                     LISA MADIGAN
Revised 10/15                   - FINANCIAL INFORMATION FORM -                        ATTORNEY GENERAL

   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, 11th Floor, Chicago, Illinois 60601.

   1.  Name, address and telephone number of the organization: ______________________________________________________________
       _____________________________________________________________________________________________________________

   2.  The books and records are located at the following address and telephone number: ___________________________________________
       _____________________________________________________________________________________________________________

   3.  Are the gross receipts for the current calendar/fiscal year expected to exceed $10,000.00? 9 Yes   9 No

   4.  Please provide the following information:

                       From inception ____________________________ thru _____________________________
                                                Month/Day/Year                            Month/Day/Year

       GROSS RECEIPTS TO DATE                                                                  ASSETS

       Contributions, Gifts & Grants            $____________________                        Cash                  $____________________

       Program Service Revenue                   _____________________                       Accounts Receivable    _____________________

       Dues                                      _____________________                       Other Receivables      _____________________

       Interest & Dividends                      _____________________                       Inventory              _____________________

       Rents                                     _____________________                       Investments            _____________________

       Fund Raising Events                       _____________________                       Land, Buildings, Equip.  _____________________

       Other Revenue                             _____________________                       Other Assets           _____________________

       TOTAL                                    $                                            TOTAL                 $                                         

       (IN LIEU OF THE ABOVE FINANCIAL INFORMATION, A CURRENT TREASURERS REPORT MAY BE SUBSTITUTED, PROVIDED THAT IT
       PROVIDES SUBSTANTIALLY THE SAME INFORMATION)

                                                CERTIFICATION

Note:  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.

Name and Title                                                                            Signature and Date Signed
______________________________________________________________________________            ____________________________________________________
Address
______________________________________________________________________________
Name and Title                                                                            Signature and Date Signed
______________________________________________________________________________            ____________________________________________________
Address
______________________________________________________________________________

Subscribed and sworn by me this ______ day of _______________, 20__ A.D.

Notary Public: ___________________________________________________