WI Farmers Union 2022 County/Local Annual Financial Statement

Authorization is hereby given to include the following financial statement in the Group Return of The Farmers Educational and Cooperative Union of America, Wisconsin Division:

County or Local Name *

Account Information:

Bank Name(s):

Checking Account: (List last four numbers of account)

Savings Account: (List last four number of account)

Authorized Signers on Accounts include:

Fiscal Year Ending: September 30, 2022 [Remember to look at 2021’s checkbook, savings, other investment balances from October 1, 2021 through Sept. 30, 2022’s balances.]

1. Balance on hand at beginning of year-Oct 1, 2021 (cash & all accounts)

INCOME

2. Membership Dues (Dues Share from WFU)

3. Education Funds Received from:

4. Interest/Dividend Income

5. Other Income (explain & include WFU Local Initiative Grants)

6. Total Income (Add Lines 2 through 5)

7. TOTAL (Lines 1 and 6 only - Beginning Balance plus Total Income)

DISBURSEMENTS

8. WFU General Fund

9. Payments to Officers/Directors

To whom and purpose:

10. Meeting/Convention expenses

11. Youth activities expenses

12. Other expenses/disbursements (Include WFU Grant Expenses)

Explain:

13. Total Disbursements (Add Lines 8 through 12 only)

14. Balance On Hand at End of Year-Sept. 30, 2022 (cash & all accounts)

15. TOTAL (Add Lines 13 and 14)

Items 7 and 15 should be the same amount. If additional space is needed for explanation, use reverse side and identify the explanation by Item number. Please include all youth activity on this form.

WFU’s fiscal responsibility is to be aware of all subsidiary union’s financial accounts and assets. This financial statement is asking for additional information to give to the auditing firm for tax purposes.

Assets - Please list all investments not previously listed:

1. Investment Firm:

	Name of Stock or Co-op Invested In	Last 4 Acct. Numbers of Investment	Amount Invested	Dividend Received	Ending Balance
1.
2.
3.

1. Building/Materials*

	List: Fair Stand; Trailer; Building; Other Materials	Permanent Location or Storage Location	Current Fair Market Value
1
2.
3.
4.

*If more space is needed, please create an inventory sheet in Excel and attach with report.

Plan for Use of Funds: (Please list your union’s plan for the use of the investments or funds whether short term or long term).

I hereby declare under the penalties of perjury that this authorization (including any accompanying statements) has been examined by me and to the best of my knowledge and belief is true, correct and complete, and made in good faith for the taxable year stated.

Date

Name

First Name Last Name