Form Summary Name of Form: Annual Report of Crime Prevention Organization – Private Non-Profit Organization Form Number: CR-243 Statutory Reference: §§757.17 and 973.06(1)(f), Wisconsin Statutes BenchBook Reference CR 37-8 Purpose of Form: To provide a standardized format for crime prevention organizations to annually report contributions received and expenditures made. Who Completes It: Officers of crime prevention organizations. Distribution of Form: Original is filed with each clerk of court that ordered a contribution to the CPO. Accompanying Forms: None New Form/Modification: Modification; last update 3/04. Modification: Deleted numbers 6 & 7 because they unnecessarily repeated numbers 4 & 5.and deleted requirement that preparer indicate time and place where form can be viewed. There is no statutory requirement for this provision. Comments: 1999 Act 58 requires that every crime prevention organization file an annual report with the clerk of each court from which it received contributions pursuant to court order. It also requires the Director of State Courts to design and provide forms for this purpose which include specific information as to receipts, expenditures and identification of the organization and its officers. 1999 Act 69 splits the definition of crime prevention organizations into private non-profit organizations and law enforcement agencies. This form is to be used for private nonprofit organizations to complete and file their annual report. Clerks are to make the forms available to crime prevention organizations. The reports must be filed with the clerk by February 1 of each year. Payments are to be made through the clerk’s office and the organizations to whom funds were distributed should be monitored to ensure compliance. About this Form: This form is the product of the Wisconsin Record Management Committee and the Director of State Court’s Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it as a separate page to this form. The form itself shall not be altered. Date: 04/21/05 American LegalNet, Inc. www.USCourtForms.com STATE OF WISCONSIN, CIRCUIT COURT For Official Use Annual Report of Crime Prevention Organization (Private Non-Profit Organization) TO: FROM: THE CLERK OF COURTS FOR COUNTY 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 Statues 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 ___ American LegalNet, Inc. www.USCourtForms.com Annual Report of Crime Prevention Organization (Private Non-Profit Organization) 3. Page ___ of ___ 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 ___ American LegalNet, Inc. www.USCourtForms.com Annual Report of Crime Prevention Organization (Private Non-Profit Organization) Page ___ of ___ Schedule A Name of Contributor/Defendant Branch Number of Court Requiring Contribution CR-243, 04/05 Annual Report of Crime Prevention Organization (Private Non-Profit Organization) Amount §757.17, Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page ___ of ___ American LegalNet, Inc. www.USCourtForms.com Annual Report of Crime Prevention Organization (Private Non-Profit Organization) Page ___ of ___ Schedule B Name of Recipient of Expenditure Amount of Expenditure 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 ___ American LegalNet, Inc. www.USCourtForms.com