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Form 990 990-EZ Or 990-PF Schedule B Schedule Of Contributors 990 - Official Federal Forms
| Form 990 990-EZ Or 990-PF Schedule B Schedule Of Contributors Form. This is a national form and can be used in Department Of Treasury . |
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Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service Schedule of Contributors Attach to Form 990, Form 990-EZ, or Form 990-PF. OMB No. 1545-0047 2012 Employer identification number Name of the organization Organization type (check one): Filers of: Form 990 or 990-EZ Section: 501(c)( ) (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. Special Rules For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 331/3 % support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II. For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III. For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more during the year . . . . . . . . . . . . . . . . . . . . . . . . $ Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2 of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Cat. No. 30613X Schedule B (Form 990, 990-EZ, or 990-PF) (2012) American LegalNet, Inc. www.FormsWorkFlow.com Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page 2 Name of organization Employer identification number Part I (a) No. Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (Complete Part II if there is a noncash contribution.) $ Schedule B (Form 990, 990-EZ, or 990-PF) (2012) American LegalNet, Inc. www.FormsWorkFlow.com Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page 3 Name of organization Employer identification number Part II (a) No. from Part I Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed. (b) Description of noncash property given (c) FMV (or estimate) (see instructions) (d) Date received $ (a) No. from Part I (c) FMV (or estimate) (see instructions) (b) Description of noncash property given (d) Date received $ (a) No. from Part I (c) FMV (or estimate) (see instructions) (b) Description of noncash property given (d) Date received $ (a) No. from Part I (c) FMV (or estimate) (see instructions) (b) Description of noncash property given (d) Date received $ (a) No. from Part I (c) FMV (or estimate) (see instructions) (b) Description of noncash property given (d) Date received $ (a) No. from Part I (c) FMV (or estimate) (see instructions) (b) Description of noncash property given (d) Date received $ Schedule B (Form 990, 990-EZ, or 990-PF) (2012) American LegalNet, Inc. www.FormsWorkFlow.com Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page 4 Name of organization Employer identification number Part III Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed. (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (a) No. from Part I (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No. from Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, ad
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