Form IFC                                   REPORT OF INDIVIDUAL                                                  LISA MADIGAN
Revised  /612                                                                                                    ATTORNEY GENERAL
                                           FUNDRAISING CAMPAIGN

CHARITY:
     Name                                                                        Reporting Period Beginning      and Ending
Mailing Address                                                                                   CO# 01-
City, State, Zip Code                                                                             Phone #
Contact Person                                           'I'itle                                  Phone #

PROFESSIONAL FUND RAISER (PFR):
Name                                                                                              PFR #02 -

NATURE OF FUNDRAISING ACTIVITY:

A. Total Amount Raised                                                                                      A. $

                                                                             PAID BY:
B. Expenses:                                             PFR                          Charity
   I.  Professional Fundraiser Fee         1.
   2  Solicitor Compensation               2.
   3.  Salaries                            3.
   4.  Printing                            4.
   5.   Postage                            5.
   6.  Telephone                           6.
   7.  Rent & Utilties                     7.
   8.  Supplies                            8.
   9.  Travel                              9.
   10.                                     10.
   11.                                     11.
   12                                      12.
   13. TOTAL EXPENSES (PFR + Charity)      13.                                                              B.  $
C. Total amount received by the charitable organization (after all expenses are paid)                       C   $
D.    Percentage of Funds received by charity (Line C  divided by  line A)                                  D.  %
E. Bank where funds are deposited? _ _ _ _ _ _ _ _ _ _ E.
F. Who (charity or PFR) has signature control of the account(s) listed above?
G. Are the expenses in B above actual expenses for this campaign?  Yes     or No If No, attach a schedule explaining in detail, how expenses are 
   allocated between fundraising campaigns.
We the undersigned, declare and certify under perjury that we have examined this report, including all the schedules, and statements, and the facts therein
stated are true and complete and filed with the Illinois Attorney General for the purpose of having the people of the State ot Illinois rely thereupon.

PFR CAMPAIGN
MANAGER (Print Name)                                                                              TITLE

SlGNATURE                                                                                         DATE

OFFICER, DIRECTOR
OF CHARITY (Print Name)                                                                           TITLE

SlGNATURE                                                                                         DATE