Form PFR-02 Revised 1/19 Filing Fee $25 PROFESSIONAL FUND RAISER ANNUAL FINANCIAL REPORT THIS MUST BE FILED BY KWAME RAOUL ATTORNEY GENERAL FILE AT: Office of the Attorney General, Charitable Trust Bureau, 100 West Randolph Street, 11th Floor, Chicago, Illinois 60601 GENERAL INSTRUCTIONS (FURTHER INSTRUCTIONS AT END OF FORM) PLEASE TYPE OR PRINT IN BLACK INK Make checks payable to the Illinois Charity Bureau Fund. A. RESPOND TO ALL ITEMS ON THIS FORM. B. CHANGES OF OR ADDITIONS TO THE INFORMATION IN THIS STATEMENT MUST BE SUBMITTED IN THIS FORMAT. C. ANNUAL REPORT (CHECK ONE): PREPARED ON ACCRUAL BASIS PREPARED ON A CASH BASIS OR PREPARED BY ANOTHER METHOD IF PREPARED BY ANOTHER METHOD EXPLAIN: LEGAL NAME MAIL ADDRESS CITY STATE ZIP CODE PHONE NUMBER REGISTERED FOR FISCAL YEAR ENDED JUNE 30, AS PFR # 02 - FEDERAL ID NUMBER REPORT IS FOR PERIOD BEGINNING JANUARY 1, AND ENDING Note: Verification must be by the Corporate President, a General Partner or the Sole Proprietor. I, under penalty of perjury and being sworn on oath state that I am (circle one) the corporate president, a general partner or the sole proprietor of the registered professional fundraiser. (Name of PFR) , have read this annual report including all attachments and personally know the contents thereof to be true, and such is state herein and filed with the Illinois Attorney General for the purpose of having the people of the State of Illinois rely thereupon. I hereby further authorize and agree to submit myself and the registrant hereby to the jurisdiction of the State of Illinois. Scribed and sworn to before me this day of 20 NOTARY PUBLIC (Signature) CHARITIES FOR WHOM FUNDS WERE RAISED TOTAL FOR ALL CHARITABLE FUNDRAISING BY PFR: STATE OF COUNTY OF } - ss AFFIDAVIT American LegalNet, Inc. www.FormsWorkFlow.com