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Sec. 157.062 Wis. Stats. State of Wisconsin Department of Financial Institutions Division of Corporate and Consumer Services

CEMETERY ASSOCIATION CERTIFICATE OF ORGANIZATION
The undersigned Chairperson and Secretary DO HEREBY CERTIFY the following: The individuals in item 4 ("organizers" ­ not less than seven (7)) who are all residents of County, Wisconsin, met on for the purpose of forming a Cemetery Association (the "Association) under Sec. 157.062, Wis. Stats. 1. The name selected for the Association by the organizers is:

2. 3.
Street

The annual meeting of the Association shall be held each year on:

______

The address of the principal office of the Association is: (Provide the complete mailing address.)
PO Box

City

State

Zip

4. ORGANIZERS (Attach schedule if necessary.) Organizer 1
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

Organizer 2
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

Organizer 3
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

NO FILING FEE
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Sec. 157.062(1) Wis. Stats.

Organizer 4
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

Organizer 5
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

Organizer 6
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

Organizer 7
Name: First Business Address: Street Home Address: Street M.I. City City Last State State Zip Zip

5.

The following Trustees (not less than three (3) nor more than nine (9)) were elected by the organizers to hold office for the terms indicated:

CLASS 1.
Name: First Business Address: Street Home Address: Street M.I. Last City City State State Term: 1 Year Zip Zip

Name: First Business Address: Street Home Address: Street

M.I.

Last City City State State

Term: 1 Year Zip Zip

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Sec. 157.062(1) Wis. Stats.

CLASS 1. ­ Trustees continued
Name: First Business Address: Street Home Address: Street M.I. Last City City State State Term: 1 Year Zip Zip

CLASS 2.
Name: First Business Address: Street Home Address: Street M.I. Last City City State State Term: 2 Years Zip Zip

Name: First Business Address: Street Home Address: Street

M.I.

Last City City State State

Term: 2 Years Zip Zip

Name: First Business Address: Street Home Address: Street

M.I.

Last City City State State

Term: 2 Years Zip Zip

CLASS 3.
Name: First Business Address: Street Home Address: Street M.I. Last City City State State Term: 3 Years Zip Zip

Name: First Business Address: Street Home Address: Street

M.I.

Last City City State State

Term: 3 Years Zip Zip

Name: First Business Address: Street Home Address: Street

M.I.

Last City City State State

Term: 3 Years Zip Zip

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Sec. 157.062(1) Wis. Stats.

6.

We further certify that the undersigned were selected by the organizers as Chairperson and Secretary.

IN WITNESS WHEREOF, the undersigned officers have executed this Certificate, in duplicate and in their respective capacities on behalf of the Association on this ___________ day of ________________________, 20_______.

_______________________________
(Chairperson Printed Name)

________________________________
(Secretary Printed Name)

_______________________________
(Chairperson Signature) NOTARY SECTION STATE OF WISCONSIN ) COUNTY OF ____________)

________________________________
(Secretary Signature)

Personally appeared before me this __________ day of ________________, 20_______, the above named __and ______ to me known to be the persons who executed the foregoing instrument in their respective capacities as officers of the aforenamed Cemetery Association and who acknowledged the same. + + (Signature of Notary)

(Printed name of Notary) + (Seal impression) My commission, issued by the State of expires on . +

INSTRUCTIONS (Ref. sec. 157.062(1), Wis. Stats. for document content.) Fee: There is no fee for filing the Cemetery Association Certificate of Organization. Delivery and Filing Procedure ­ Submit one original and one exact copy to: Mailing Address: Physical Address: Department of Financial Institutions Department of Financial Institutions Division of Corporate and Consumer Division of Corporate and Consumer Services Services PO Box 7846 345 W. Washington Ave., 3rd Floor Madison WI, 53707-7846 Madison WI 53703

Phone: 608-261-7577 Fax: 608-267-6813 TTY: 608-266-8818

The original will be filed and retained by the Department of Financial Institutions. The stamped duplicate will be returned to the name and address indicated on page 5 of the form 401. NOTICE: This form may be used to accomplish a filing required or permitted by statute to be made with the department. Information requested may be used for secondary purposes. This document can be made available in alternate formats upon request to qualifying individuals with disabilities.
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Sec. 157.062(1) Wis. Stats.

CEMETERY ASSOCIATION CERTIFICATE OF ORGANIZATION Return filed duplicate to: (Enter your name and return address below.)

Your phone number during the day: ( INSTRUCTIONS - continued

) ________-_____________.

Organizing a Cemetery Association ­ Seven or more residents of the same county may form a cemetery association. The organizers must hold a meeting, select a chairperson and secretary, choose a name for the Association, fix the annual meeting date, and elect by ballot not less than three nor more than nine trustees. Immediately following the election, the chairperson and secretary must divide the number of trustees into three classes having one, two and three year terms, respectively. Within three days of the meeting, the chairperson and secretary must certify the corporate name of the Association, the names, home addresses and business addresses of the organizers and the trustees, and their classifications and the annual meeting date acknowledged by them and deliver the certification to the Department of Financial Institutions. The Association then has the powers of a corporation. Item 1: Enter the name of the cemetery association selected by the organizers. Item 2: Enter the date the annual meeting of the cemetery association will be held each year. Item 3: Enter the complete address of the principal office address of the cemetery association. Item 4: Enter the name, home address and business address of all organizers (not less than 7). Item 5: Enter the name, home address and business address of all trustees (not less than 3 nor more than 9) elected by the organizers. The chairperson and secretary shall divide the trustees into 3 classes, who shall hold their offices for 1, 2 and 3 years, respectively. Item 6: Execution ­ This document must be executed by the chairperson and secretary in the presence of a Notary Public. The names of the chairperson and secretary should be stated in the Notary paragraph exactly as they appear in the document signatures in item 6. The Notary must also sign, apply his/her official seal and indicate the expiration date of his/her commission. GENERAL INFORMATION: Annual Report Requirement: Cemetery Associations formed under sec. 157.062, Wis. Stats., are required to file an annual report with the Department of Financial Institutions. The report is due March 1st of each year. Report forms will be mailed about January 1st to the Association at its principal office address on record with the Department of Financial Institutions. Report forms may also be requested from the Department of Financial Institutions by contacting the Division Of Corporate and Consumer Services at (608)261-7577. . EXCERPT ­ 1991 WISCONSIN ACT 269 157.062(9) Exemptions for Certain Nonprofit Cemeteries In lieu of delivering a certification, resolution or copy of proceedings to the Department of Financial Institutions, under sub. (1), (2) or (6)(b), a cemetery association that is not required to be registered under s.440.91(1) and that is not organized or conducted for pecuniary profit shall deliver the certification, resolution or copy of proceedings to the office of the register of deeds of the county in which the cemetery is located. Particulars on registration requirements under s.440.91(1) may be obtained from Department of Regulation and Licensing, Attn: Cemetery Regulation, PO Box 8935, Madison, WI 53707.
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