Form 1023 Application For Recognition Of Exemption Under Section 501(c) (3) {1023} | Pdf Doc Docx | Kramer Levin

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Form 1023 Application For Recognition Of Exemption Under Section 501(c) (3) {1023} | Pdf Doc Docx | Kramer Levin

Form 1023 Application For Recognition Of Exemption Under Section 501(c) (3) {1023}

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Form (Rev. June 2006) 1023 Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code OMB No. 1545-0056 Note: If exempt status is approved, this application will be open for public inspection. Department of the Treasury Internal Revenue Service Use the instructions to complete this application and for a definition of all bold items. For additional help, call IRS Exempt Organizations Customer Account Services toll-free at 1-877-829-5500. Visit our website at www.irs.gov for forms and publications. If the required information and documents are not submitted with payment of the appropriate user fee, the application may be returned to you. Attach additional sheets to this application if you need more space to answer fully. Put your name and EIN on each sheet and identify each answer by Part and line number. Complete Parts I - XI of Form 1023 and submit only those Schedules (A through H) that apply to you. Part I 1 Identification of Applicant 2 c/o Name (if applicable) Full name of organization (exactly as it appears in your organizing document) 3 Mailing address (Number and street) (see instructions) Room/Suite 4 Employer Identification Number (EIN) City or town, state or country, and ZIP + 4 5 Month the annual accounting period ends (01 ­ 12) 6 Primary contact (officer, director, trustee, or authorized representative) a Name: b Phone: c Fax: (optional) 7 Are you represented by an authorized representative, such as an attorney or accountant? If "Yes," provide the authorized representative's name, and the name and address of the authorized representative's firm. Include a completed Form 2848, Power of Attorney and Declaration of Representative, with your application if you would like us to communicate with your representative. Was a person who is not one of your officers, directors, trustees, employees, or an authorized representative listed in line 7, paid, or promised payment, to help plan, manage, or advise you about the structure or activities of your organization, or about your financial or tax matters? If "Yes," provide the person's name, the name and address of the person's firm, the amounts paid or promised to be paid, and describe that person's role. Yes No 8 Yes No 9a Organization's website: b Organization's email: (optional) 10 Certain organizations are not required to file an information return (Form 990 or Form 990-EZ). If you are granted tax-exemption, are you claiming to be excused from filing Form 990 or Form 990-EZ? If "Yes," explain. See the instructions for a description of organizations not required to file Form 990 or Form 990-EZ. Date incorporated if a corporation, or formed, if other than a corporation. Were you formed under the laws of a foreign country? If "Yes," state the country. Cat. No. 17133K Form Yes No 11 12 (MM/DD/YYYY) / / Yes No For Paperwork Reduction Act Notice, see page 24 of the instructions. 1023 (Rev. 6-2006) Form 1023 (Rev. 6-2006) Name: EIN: ­ Page 2 Part II Organizational Structure You must be a corporation (including a limited liability company), an unincorporated association, or a trust to be tax exempt. (See instructions.) DO NOT file this form unless you can check "Yes" on lines 1, 2, 3, or 4. 1 Are you a corporation? If "Yes," attach a copy of your articles of incorporation showing certification of filing with the appropriate state agency. Include copies of any amendments to your articles and be sure they also show state filing certification. Are you a limited liability company (LLC)? If "Yes," attach a copy of your articles of organization showing certification of filing with the appropriate state agency. Also, if you adopted an operating agreement, attach a copy. Include copies of any amendments to your articles and be sure they show state filing certification. Refer to the instructions for circumstances when an LLC should not file its own exemption application. Are you an unincorporated association? If "Yes," attach a copy of your articles of association, constitution, or other similar organizing document that is dated and includes at least two signatures. Include signed and dated copies of any amendments. Yes No 2 Yes No 3 Yes No 4a Are you a trust? If "Yes," attach a signed and dated copy of your trust agreement. Include signed and dated copies of any amendments. b Have you been funded? If "No," explain how you are formed without anything of value placed in trust. 5 Have you adopted bylaws? If "Yes," attach a current copy showing date of adoption. If "No," explain how your officers, directors, or trustees are selected. Yes Yes Yes No No No Part III Required Provisions in Your Organizing Document The following questions are designed to ensure that when you file this application, your organizing document contains the required provisions to meet the organizational test under section 501(c)(3). Unless you can check the boxes in both lines 1 and 2, your organizing document does not meet the organizational test. DO NOT file this application until you have amended your organizing document. Submit your original and amended organizing documents (showing state filing certification if you are a corporation or an LLC) with your application. 1 Section 501(c)(3) requires that your organizing document state your exempt purpose(s), such as charitable, religious, educational, and/or scientific purposes. Check the box to confirm that your organizing document meets this requirement. Describe specifically where your organizing document meets this requirement, such as a reference to a particular article or section in your organizing document. Refer to the instructions for exempt purpose language. Location of Purpose Clause (Page, Article, and Paragraph): 2a Section 501(c)(3) requires that upon dissolution of your organization, your remaining assets must be used exclusively for exempt purposes, such as charitable, religious, educational, and/or scientific purposes. Check the box on line 2a to confirm that your organizing document meets this requirement by express provision for the distribution of assets upon dissolution. If you rely on state law for your dissolution provision, do not check the box on line 2a and go to line 2c. 2b If you checked the box on line 2a, specify the location of your dissolution clause (Page, Article, and Paragraph). Do not complete line 2c if you checked box 2a. 2c See the instructions for information about the operation of state law in your particular state. Check this box if you rely on

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