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Sec. 157.062(3) Wis. Stats.

State of Wisconsin Department of Financial Institutions Division of Corporate and Consumer Services

CEMETERY ASSOCIATION AFFIDAVIT OF VALIDATION (IN EXISTENCE FOR MORE THAN 25 YEARS)
The undersigned Chairperson and Secretary of: , a Wisconsin Cemetery Association (the "Association") having its principal place of business in the following: County, Wisconsin do hereby certify

1.

A bona fide attempt was made to organize the Association on (date)

but that the Association failed to record a properly drawn and executed Certificate of Organization.

2.

The Association has in good faith conducted business as a cemetery association for more than

25 years, including the purchase and platting of cemetery grounds and the conveyance of cemetery lots.

3.

The date on which real estate was first conveyed to the Association and on which its transfers

and other transactions were validated is:

4.

Attached to this Affidavit is an executed Certificate of Organization submitted for the purpose

of establishing the continued existence of the Association. (Complete and attach form 401 Cemetery Association Certificate of Organization.)

NO FILING FEE
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Sec. 157.062(3) Wis. Stats.

5.

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) ______________________________ (Chairperson Signature) NOTARY SECTION STATE OF WISCONSIN ) COUNTY OF _____________)

_____________________________
(Secretary Printed Name) ________________________________ (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)

+ (Seal impression)

+

(Printed name of Notary)

My commission, issued by the State of

expires on

______

.

INSTRUCTIONS: (Ref. Sec. 157.062(3), Wis. Stats. for document content) Fee: There is no fee for filing the Cemetery Association Affidavit of Validation (In Existence for more than 25 years). 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 3 of the form 402.
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Sec. 157.062(3) Wis. Stats.

CEMETERY ASSOCIATION AFFIDAVIT OF VALIDATION (IN EXISTENCE FOR MORE THAN 25 YEARS) Return filed duplicate to: (Enter your name and return address below.)

Your phone number during the day: (
INSTRUCTIONS ­ continued

) ________-_____________.

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. Items 1 ­ 4: Validation of a Cemetery Association ­ When there shall have been a bona fide attempt to organize a cemetery association, but failure to record a properly drawn and executed certificate of organization, and it has in good faith bought and platted grounds and conveyed cemetery lots and carried on business for over 25 years, the same shall be a body corporate from the date of conveyance to it of real estate, and its transfers and other transactions were validated. The Chairperson and Secretary of the Cemetery Association must certify items 1 ­ 4. Item 5: 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 5. 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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