Form 1024 & Instructions
Application for Recognition of Exemption Under Section 501(a)
(Rev. January 2018)

Cat. No. 71472G
OMB No. 1545-0057

Department of the Treasury
Internal Revenue Service

For Paperwork Reduction Act Notice, see instructions.

In 1 File
Print pages 1-19 and 1-6

CONTENTS

Section: Page

Form 1024 Application for Recognition of Exemption Under Section 501(a): 1
Instructions for Form 1024: 1
   Future Developments: 1
   What's New: 1
   General Instructions: 1
      Purpose of Form: 1
      What To File: 1
      Attachments: 1
      When To File (Section 501(c)(9) or (17) Organization): 1
      Where To File: 1
      Signature Requirements: 2
         After You Submit Form 1024: 2
      Language and Currency Requirements: 2
         Example: 2
      Annual Information Return: 2
      Annual Filing Requirements: 2
      Public Inspection: 2
   Specific Instructions: 3
      Part I. Identification of Applicant: 3
      Part II. Activities and Operational Information: 3
      Part III. Financial Data: 4
         A. Statement of Revenue and Expenses: 4
         B. Balance Sheet: 5
      Part IV. Notice Requirements: 5

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Application for Recognition of Exemption Under Section 501(a)

Go to www.irs.gov/Form1024 for instructions and the latest information.

If exempt status is approved, this application will be open for public inspection.

Read the instructions for each Part carefully. A User Fee must be attached to this application.

If the required information and appropriate documents are not submitted along with Form 8718 (with payment of the appropriate user fee), the application may be returned to the organization.

Complete the Procedural Checklist that follows the form.

Part I. Identification of Applicant Must be completed by all applicants; also complete appropriate schedule. Submit only the schedule that applies to your organization. Do not submit blank schedules.

Check the appropriate box below to indicate the section under which the organization is applying:

a. -- Section 501(c)(2)Title holding corporations (Schedule A)
b. -- Shaded Reserved for future use
c. -- Section 501(c)(5)Labor, agricultural, or horticultural organizations (Schedule C)
d. -- Section 501(c)(6)Business leagues, chambers of commerce, etc. (Schedule C)
e. -- Section 501(c)(7)Social clubs (Schedule D)
f. -- Section 501(c)(8)Fraternal beneficiary societies, etc., providing life, sick, accident, or other benefits to members (Schedule E)
g. -- Section 501(c)(9)Voluntary employees beneficiary associations (Parts I through IV and Schedule F)
h. -- Section 501(c)(10)Domestic fraternal societies, orders, etc., not providing life, sick, accident, or other benefits (Schedule E)
i. -- Section 501(c)(12)Benevolent life insurance associations, mutual ditch or irrigation companies, mutual or cooperative telephone companies, or like organizations (Schedule G)
j. -- Section 501(c)(13)Cemeteries, crematoria, and like corporations (Schedule H)
k. -- Section 501(c)(15)Mutual insurance companies or associations, other than life or marine (Schedule I)
l. -- Section 501(c)(17)Trusts providing for the payment of supplemental unemployment compensation benefits (Parts I through IV and Schedule J)
m. -- Section 501(c)(19)A post, organization, auxiliary unit, etc., of past or present members of the Armed Forces of the United States (Schedule K)
n. -- Section 501(c)(25)Title holding corporations or trusts (Schedule A)

1a. Full name of organization (as shown in organizing document): ----
1b. c/o Name (if applicable): ----
1c. Address (number and street): ----
   Room/Suite: ----
1d. City, town or post office, state, and ZIP + 4. If you have a foreign address, see Specific Instructions for Part I.: ----
1e. Web site address: ----
2. Employer identification number (EIN) (if none, see Specific Instructions): ----
3. Name and telephone number of person to be contacted if additional information is needed: (----) ----
4. Month the annual accounting period ends: ----
5. Date incorporated or formed: ----
6. Did the organization previously apply for recognition of exemption under this Code section or under any other section of the Code?
   -- Yes
   -- No
If Yes, attach an explanation.
7. Has the organization filed Federal income tax returns or exempt organization information returns?
   -- Yes
   -- No
If Yes, state the form numbers, years filed, and Internal Revenue office where filed.: ----
8. Check the box for the type of organization. ATTACH A CONFORMED COPY OF THE CORRESPONDING ORGANIZING DOCUMENTS TO THE APPLICATION BEFORE MAILING.
   a. -- Corporation Attach a copy of the Articles of Incorporation (including amendments and restatements) showing approval by the appropriate state official; also attach a copy of the bylaws.
   b. -- Trust Attach a copy of the Trust Indenture or Agreement, including all appropriate signatures and dates.
   c. -- Association Attach a copy of the Articles of Association, Constitution, or other creating document, with a declaration (see instructions) or other evidence that the organization was formed by adoption of the document by more than one person. Also include a copy of the bylaws.

If this is a corporation or an unincorporated association that has not yet adopted bylaws, check here: --

I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization, and that I have examined this application, including the accompanying schedules and attachments, and to the best of my knowledge it is true, correct, and complete.

PLEASE SIGN HERE 

---- (Signature)
---- (Type or print name and title or authority of signer)
---- (Date)

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Part II. Activities and Operational Information (Must be completed by all applicants)

1. Provide a detailed narrative description of all the activities of the organizationpast, present, and planned. Do not merely refer to or repeat the language in the organizational document. List each activity separately in the order of importance based on the relative time and other resources devoted to the activity. Indicate the percentage of time for each activity. Each description should include, as a minimum, the following: (a) a detailed description of the activity including its purpose and how each activity furthers your exempt purpose; (b) when the activity was or will be initiated; and (c) where and by whom the activity will be conducted.: ----

2. List the organizations present and future sources of financial support, beginning with the largest source first.: ----

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3. Give the following information about the organizations governing body:
   a. Names, addresses, and titles of officers, directors, trustees, etc.: ----
   b. Annual compensation: ----
4. If the organization is the outgrowth or continuation of any form of predecessor, state the name of each predecessor, the period during which it was in existence, and the reasons for its termination. Submit copies of all papers by which any transfer of assets was effected.: ----
5. If the applicant organization is now, or plans to be, connected in any way with any other organization, describe the other organization and explain the relationship (for example, financial support on a continuing basis; shared facilities or employees; same officers, directors, or trustees).: ----
6. If the organization has capital stock issued and outstanding, state: (1) class or classes of the stock; (2) number and par value of the shares; (3) consideration for which they were issued; and (4) if any dividends have been paid or whether your organizations creating instrument authorizes dividend payments on any class of capital stock.: ----
7. State the qualifications necessary for membership in the organization; the classes of membership (with the number of members in each class); and the voting rights and privileges received. If any group or class of persons is required to join, describe the requirement and explain the relationship between those members and members who join voluntarily. Submit copies of any membership solicitation material. Attach sample copies of all types of membership certificates issued.: ----
8. Explain how your organizations assets will be distributed on dissolution.: ----

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9. Has the organization made or does it plan to make any distribution of its property or surplus funds to shareholders or members?
   -- Yes
   -- No
If Yes, state the full details, including: (1) amounts or value; (2) source of funds or property distributed or to be distributed; and (3) basis of, and authority for, distribution or planned distribution.: ----
10. Does, or will, any part of your organizations receipts represent payments for services performed or to be performed?
   -- Yes
   -- No
If. Yes, state in detail the amount received and the character of the services performed or to be performed.: ----
11. Has the organization made, or does it plan to make, any payments to members or shareholders for services performed or to be performed?
   -- Yes
   -- No
If Yes, state in detail the amount paid, the character of the services, and to whom the payments have been, or will be, made.: ----
12. Does the organization have any arrangement to provide insurance for members, their dependents, or others (including provisions for the payment of sick or death benefits, pensions, or annuities)?
   -- Yes
   -- No
If Yes, describe and explain the arrangements eligibility rules and attach a sample copy of each plan document and each type of policy issued.: ----
13. Is the organization under the supervisory jurisdiction of any public regulatory body, such as a social welfare agency, etc.?
   -- Yes
   -- No
If Yes, submit copies of all administrative opinions or court decisions regarding this supervision, as well as copies of applications or requests for the opinions or decisions.
14. Does the organization now lease or does it plan to lease any property?
   -- Yes
   -- No
If Yes, explain in detail. Include the amount of rent, a description of the property, and any relationship between the applicant organization and the other party. Also, attach a copy of any rental or lease agreement. (If the organization is a party, as a lessor, to multiple leases of rental real property under similar lease agreements, please attach a single representative copy of the leases.): ----
15. Has the organization spent or does it plan to spend any money attempting to influence the selection, nomination, election, or appointment of any person to any federal, state, or local public office or to an office in a political organization?
   -- Yes
   -- No
If Yes, explain in detail and list the amounts spent or to be spent in each case.: ----
16. Does the organization publish pamphlets, brochures, newsletters, journals, or similar printed material?
   -- Yes
   -- No
If Yes, attach a recent copy of each.

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Part III. Financial Data (Must be completed by all applicants)

Complete the financial statements for the current year and for each of the 3 years immediately before it. If in existence less than 4 years, complete the statements for each year in existence. If in existence less than 1 year, also provide proposed budgets for the 2 years following the current year.

A. Statement of Revenue and Expenses

Note: In this table, columns follow each other in this order: Revenue; (a) Current Tax Year From ---- To ----; (b) 3 Prior Tax Years or Proposed Budget for Next 2 Years; (c) 3 Prior Tax Years or Proposed Budget for Next 2 Years; (d) 3 Prior Tax Years or Proposed Budget for Next 2 Years; (e) Total.

1. Gross dues and assessments of members; ----; ----; ----; ----.
2. Gross contributions, gifts, etc.; ----; ----; ----; ----.
3. Gross amounts derived from activities related to the organizations exempt purpose (attach schedule) (Include related cost of sales on line 9.); ----; ----; ----; ----.
4. Gross amounts from unrelated business activities (attach schedule); ----; ----; ----; ----.
5. Gain from sale of assets, excluding inventory items (attach schedule); ----; ----; ----; ----.
6. Investment income (see instructions); ----; ----; ----; ----.
7. Other revenue (attach schedule); ----; ----; ----; ----.
8. Total revenue (add lines 1 through 7); ----; ----; ----; ----.
9. Expenses attributable to activities related to the organizations exempt purposes; ----; ----; ----; ----.
10. Expenses attributable to unrelated business activities; ----; ----; ----; ----.
11. Contributions, gifts, grants, and similar amounts paid (attach schedule); ----; ----; ----; ----.
12. Disbursements to or for the benefit of members (attach schedule); ----; ----; ----; ----.
13. Compensation of officers, directors, and trustees (attach schedule); ----; ----; ----; ----.
14. Other salaries and wages; ----; ----; ----; ----.
15. Interest; ----; ----; ----; ----.
16. Occupancy; ----; ----; ----; ----.
17. Depreciation and depletion; ----; ----; ----; ----.
18. Other expenses (attach schedule); ----; ----; ----; ----.
19. Total expenses (add lines 9 through 18); ----; ----; ----; ----.
20. Excess of revenue over expenses (line 8 minus line 19); ----; ----; ----; ----.

B. Balance Sheet (at the end of the period shown)

Note: In this table, columns follow each other in this order: Assets; Current Tax Year as of ----.

1. Cash; 1 ----.
2. Accounts receivable, net; 2 ----.
3. Inventories; 3 ----.
4. Bonds and notes receivable (attach schedule); 4 ----.
5. Corporate stocks (attach schedule); 5 ----.
6. Mortgage loans (attach schedule); 6 ----.
7. Other investments (attach schedule); 7 ----.
8. Depreciable and depletable assets (attach schedule); 8 ----.
9. Land; 9 ----.
10. Other assets (attach schedule); 10 ----.
11. Total assets; 11 ----.

Note: In this table, columns follow each other in this order: Liabilities; Current Tax Year as of ----.

12. Accounts payable; 12 ----.
13. Contributions, gifts, grants, etc., payable; 13 ----.
14. Mortgages and notes payable (attach schedule); 14 ----.
15. Other liabilities (attach schedule); 15 ----.
16. Total liabilities; 16 ----.

Note: In this table, columns follow each other in this order: Fund Balances or Net Assets; Current Tax Year as of ----.

17. Total fund balances or net assets; 17 ----.
18. Total liabilities and fund balances or net assets (add line 16 and line 17); 18 ----.

If there has been any substantial change in any aspect of the organizations financial activities since the end of the period shown above, check the box and attach a detailed explanation: --

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Part IV. Notice Requirements (Sections 501(c)(9) and 501(c)(17) Organizations Only)

1. Section 501(c)(9) and 501(c)(17) organizations:
Are you filing Form 1024 within 15 months from the end of the month in which the organization was created or formed as required by section 505(c)?
   -- Yes
   -- No
If Yes, skip the rest of this part.
If No, answer question 2.

2. If you answer No to question 1, are you filing Form 1024 within 27 months from the end of the month in which the organization was created or formed?
   -- Yes
   -- No
If Yes, your organization qualifies under Regulations section 301.9100-2 for an automatic 12-month extension of the 15-month filing requirement. Do not answer questions 3 and 4.
If No, answer question 3.

3. If you answer No to question 2, does the organization wish to request an extension of time to apply under the reasonable action and good faith and the no prejudice to the interest of the government requirements of Regulations section 301.9100-3?
   -- Yes
   -- No
If Yes, give the reasons for not filing this application within the 27-month period described in question 2. See Specific Instructions, Part IV, Line 3, before completing this item. Do not answer question 4.
If No, answer question 4.: ----

4. If you answer No to question 3, your organizations qualification as a section 501(c)(9) or 501(c)(17) organization can be recognized only from the date this application is filed. Therefore, does the organization want us to consider its application as a request for recognition of exemption as a section 501(c)(9) or 501(c)(17) organization from the date the application is received and not retroactively to the date the organization was created or formed?
   -- Yes
   -- No

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Schedule A Organizations described in section 501(c)(2) or 501(c)(25) (Title-holding corporations or trusts)

1. State the complete name, address, and EIN of each organization for which title to property is held and the number and type of the applicant organizations stock held by each organization.: ----
2. If the annual excess of revenue over expenses has not been or will not be turned over to the organization for which title to property is held, state the purpose for which the excess is or will be retained by the title holding organization.: ----
3. In the case of a corporation described in section 501(c)(2), state the purpose of the organization for which title to property is held (as shown in its governing instrument) and the Code sections under which it is classified as exempt from tax. If the organization has received a determination or ruling letter recognizing it as exempt from taxation, please attach a copy of the letter.: ----
4. In the case of a corporation or trust described in section 501(c)(25), state the basis whereby each shareholder is described in section 501(c)(25)(C). For each organization described that has received a determination or ruling letter recognizing that organization as exempt from taxation, please attach a copy of the letter.: ----
5. With respect to the activities of the organization.
   a. Is any rent received attributable to personal property leased with real property?
      -- Yes
      -- No
   If Yes, what percentage of the total rent, as reported on the financial statements in Part III, is attributable to personal property?: ----
   b. Will the organization receive income which is incidentally derived from the holding of real property, such as income from operation of a parking lot or from vending machines?
      -- Yes
      -- No
   If Yes, what percentage of the organizations gross income, as reported on the financial statements in Part III, is incidentally derived from the holding of real property?: ----
   c. Will the organization receive income other than rent from real property or personal property leased with real property or income which is incidentally derived from the holding of real property?
      -- Yes
      -- No
   If Yes, describe the source of the income.: ----

Instructions

Line 1.Provide the requested information on each organization for which the applicant organization holds title to property. Also indicate the number and types of shares of the applicant organizations stock that are held by each.

Line 2.For purposes of this question, excess of revenue over expenses is all of the organizations income for a particular tax year less operating expenses.

Line 3.Give the exempt purpose of each organization that is the basis for its exempt status and the Internal Revenue Code section that describes the organization (as shown in its IRS determination letter).

Line 4.Indicate if the shareholder is one of the following.

1. A qualified pension, profit-sharing, or stock bonus plan that meets the requirements of the Code;
2. A government plan;
3. An organization described in section 501(c)(3); or
4. An organization described in section 501(c)(25).

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Schedule C Organizations described in section 501(c)(5) (Labor, agricultural, including fishermens organizations, or horticultural organizations) or section 501(c)(6) (business leagues, chambers of commerce, etc.)

1. Describe any services the organization performs for members or others. (If the description of the services is contained in Part II of the application, enter the page and item number here.): ----
2. Fishermens organizations only.What kinds of aquatic resources (not including mineral) are cultivated or harvested by those eligible for membership in the organization?: ----
3. Labor organizations only.Is the organization organized under the terms of a collective bargaining agreement?
   -- Yes
   -- No
If Yes, attach a copy of the latest agreement.: ----

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Schedule D Organizations described in section 501(c)(7) (Social clubs)

1. Has the organization entered or does it plan to enter into any contract or agreement for the management or operation of its property and/or activities, such as restaurants, pro shops, lodges, etc.?
   -- Yes
   -- No
If Yes, attach a copy of the contract or agreement. If one has not yet been drawn up, please explain the organizations plans.: ----
2. Does the organization seek or plan to seek public patronage of its facilities or activities by advertisement or otherwise?
   -- Yes
   -- No
If Yes, attach sample copies of the advertisements or other requests. If the organization plans to seek public patronage, please explain the plans.: ----
3a. Are nonmembers, other than guests of members, permitted or will they be permitted to use the club facilities or participate in or attend any functions or activities conducted by the organization?
   -- Yes
   -- No
If Yes, describe the functions or activities in which there has been or will be nonmember participation or admittance. (Submit a copy of the house rules, if any.): ----
   b. State the amount of nonmember income included in Part III of the application, lines 3 and 4, column (a): ----
   c. Enter the percent of gross receipts from nonmembers for the use of club facilities: ----%
   d. Enter the percent of gross receipts received from investment income and nonmember use of the clubs facilities: ----%
4a. Does the organizations charter, bylaws, other governing instrument, or any written policy statement of the organization contain any provision that provides for discrimination against any person on the basis of race, color, or religion?
   -- Yes
   -- No
   b. If Yes, state whether or not its provision will be kept.: ----
   c. If the organization has such a provision that will be repealed, deleted, or otherwise stricken from its requirements, state when this will be done: ----
   d. If the organization formerly had such a requirement and it no longer applies, give the date it ceased to apply: ----
   e. If the organization restricts its membership to members of a particular religion, check here and attach the explanation specified in the instructions: ----

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Instructions

Line 1.Answer Yes, if any of the organizations property or activities will be managed by another organization or company.

Lines 3b, c, and d.Enter the figures for the current year. On an attached schedule, furnish the same information for each of the prior tax years for which you completed Part III of the application.

Line 4e.If the organization restricts its membership to members of a particular religion, the organization must be:
  
1. An auxiliary of a fraternal beneficiary society that:
  a. Is described in section 501(c)(8) and exempt from tax under section 501(a), and
  b. Limits its membership to members of a particular religion; or
2. A club that, in good faith, limits its membership to the members of a particular religion in order to further the teachings or principles of that religion and not to exclude individuals of a particular race or color.

If you checked 4e, your explanation must show how the organization meets one of these two requirements.

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Schedule E Organizations described in section 501(c)(8) or 501(c)(10) (Fraternal societies, orders, or associations)

1. Is the organization a college fraternity or sorority, or chapter of a college fraternity or sorority?
   -- Yes
   -- No
If Yes, read the instructions for Line 1, below, before completing this schedule.
2. Does or will your organization operate under the lodge system?
   -- Yes
   -- No
If No, does or will it operate for the exclusive benefit of the members of an organization operating under the lodge system?
   -- Yes
   -- No
3. Is the organization a subordinate or local lodge, etc.?
   -- Yes
   -- No
If Yes, attach a certificate signed by the secretary of the parent organization, under the seal of the organization, certifying that the subordinate lodge is a duly constituted body operating under the jurisdiction of the parent body.
4. Is the organization a parent or grand lodge?
   -- Yes
   -- No
If Yes, attach a schedule for each subordinate lodge in active operation showing: (a) its name and address; (b) the number of members in it; and (c) how often it holds periodic meetings.

Instructions

Line 1.To the extent that they qualify for exemption from federal income tax, college fraternities and sororities generally qualify as organizations described in section 501(c)(7). Therefore, if the organization is a college fraternity or sorority, refer to the discussion of section 501(c)(7) organizations in Pub. 557. If section 501(c)(7) appears to apply to your organization, complete Schedule D instead of this schedule.

Line 2.Operating under the lodge system means carrying on activities under a form of organization that is composed of local branches, chartered by a parent organization, largely self-governing, and called lodges, chapters, or the like.

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Schedule F Organizations described in section 501(c)(9) (Voluntary employees beneficiary associations)

1. Describe the benefits available to members. Include copies of any plan documents that describe such benefits and the terms and conditions of eligibility for each benefit.: ----
2. Are any employees or classes of employees entitled to benefits to which other employees or classes of employees are not entitled?
   -- Yes
   -- No
If Yes, explain.: ----
3. Give the following information for each plan as of the last day of the most recent plan year and enter that date here. If there is more than one plan, attach a separate schedule: ---- (mo.) ---- (day) ---- (yr.)
   a. Total number of persons covered by the plan who are highly compensated individuals (See instructions below.): ----
   b. Number of other employees covered by the plan: ----
   c. Number of employees not covered by the plan: ----
   d. Total number employed[footnote *]: ----
Footnote *] Should equal the total of a, b, and cif not, explain any difference. Describe the eligibility requirements that prevent those employees not covered by the plan from participating.
4. State the number of persons, if any, other than employees and their dependents (for example, the proprietor of a business whose employees are members of the association) who are entitled to receive benefits: ----

Instructions

Line 3a.A highly compensated individual is one who:

(a) Owned 5% or more of the employer at any time during the current year or the preceding year,
(b) Received more than $80,000 (adjusted for inflation) in compensation from the employer for the preceding year, and
(c) Was among the top 20% of employees by compensation for the preceding year. However, the employer can choose not to have (c) apply.

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Schedule G Organizations described in section 501(c)(12) (Benevolent life insurance associations, mutual ditch or irrigation companies, mutual or cooperative telephone companies, or like organizations)

1. Attach a schedule in columnar form for each tax year for which the organization is claiming exempt status. On each schedule:
   a. Show the total gross income received from members or shareholders.: ----
   b. List, by source, the total amounts of gross income received from other sources.: ----
2. If the organization is claiming exemption as a local benevolent insurance association, state:
   a. The counties from which members are accepted or will be accepted.: ----
   b. Whether stipulated premiums are or will be charged in advance, or whether losses are or will be paid solely through assessments.: ----
3. If the organization is claiming exemption as a like organization, explain how it is similar to a mutual ditch or irrigation company, or a mutual or cooperative telephone company.: ----
4. Are the rights and interests of members in the organizations annual savings determined in proportion to their business with it?
   -- Yes
   -- No
If Yes, does the organization keep the records necessary to determine at any time each members rights and interests in such savings, including assets acquired with the savings?
   -- Yes
   -- No
5. If the organization is a mutual or cooperative telephone company and has contracts with other systems for long-distance telephone services, attach copies of the contracts.: ----

Instructions

Mutual or cooperative electric or telephone companies should show income received from qualified pole rentals separately. Mutual or cooperative telephone companies should also show separately the gross amount of income received from nonmember telephone companies for performing services that involve their members and the gross amount of income received from the sale of display advertising in a directory furnished to their members.

Do not net amounts due or paid to other sources against amounts due or received from those sources.

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Schedule H Organizations described in section 501(c)(13) (Cemeteries, crematoria, and like corporations)

1. Attach the following documents.
   a. Complete copy of sales contracts or other documents, including any debt certificates, involved in acquiring cemetery or crematorium property.
   b. Complete copy of any contract your organization has that designates an agent to sell its cemetery lots.
   c. A copy of the appraisal (obtained from a disinterested and qualified party) of the cemetery property as of the date acquired.
2. Does your organization have, or does it plan to have, a perpetual care fund?
   -- Yes
   -- No
If Yes, attach a copy of the fund agreement and explain the nature of the fund (cash, securities, unsold land, etc.).: ----
3. If your organization is claiming exemption as a perpetual care fund for an organization described in section 501(c)(13), has the cemetery organization, for which funds are held, established exemption under that section?
   -- Yes
   -- No
If No, explain.: ----

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Schedule I Organizations described in section 501(c)(15) (Small insurance companies or associations)

1. Is the organization a member of a controlled group of corporations as defined in section 831(b)(2)(B)(ii)? (Disregard section 1563(b)(2)(B) in determining whether the organization is a member of a controlled group.)
   -- Yes
   -- No
If Yes, include on lines 2 through 5 the total amount received by the organization and all other members of the controlled group.
If No, include on lines 2 through 5 only the amounts that relate to the applicant organization.

Note: In the following tables, columns follow each other in this order: (a) Current Year From ---- To ----; (b) 3 Prior Tax Years; (c) 3 Prior Tax Years; (d) 3 Prior Tax Years: ----.

2. Direct written premiums
  
----; ----; ----; ----.

3. Reinsurance assumed

----; ----; ----; ----.

4. Reinsurance ceded

----; ----; ----; ----.

5. Net written premiums ((line 2 plus line 3) minus line 4)

----; ----; ----; ----.

6. If you entered an amount on line 3 or line 4, attach a copy of the reinsurance agreements the organization has entered into.

Instructions

Line 1.Answer Yes, if the organization would be considered a member of a controlled group of corporations if it were not exempt from tax under section 501(a). In applying section 1563(a), use a more than 50% stock ownership test to determine whether the applicant or any other corporation is a member of a controlled group.

Line 2.In addition to other direct written premiums, include on line 2 the full amount of any prepaid or advance premium in the year the prepayment is received. For example, if a $5,000 premium for a 3-year policy was received in the current year, include the full $5,000 amount in the Current Year column.

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Schedule J Organizations described in section 501(c)(17) (Trusts providing for the payment of supplemental unemployment compensation benefits)

1. If benefits are provided for individual proprietors, partners, or self-employed persons under the plan, explain in detail.: ----
2. If the plan provides other benefits in addition to the supplemental unemployment compensation benefits, explain in detail and state whether the other benefits are subordinate to the unemployment benefits.: ----
3. Give the following information as of the last day of the most recent plan year and enter that date here: ----
   a. Total number of employees covered by the plan who are shareholders, officers, self-employed persons, or highly compensated (See Schedule F instructions for line 3a.): ----
   b. Number of other employees covered by the plan: ----
   c. Number of employees not covered by the plan: ----
   d. Total number employed [Footnote*] : ----
[Footnote *] Should equal the total of a, b, and cif not, explain the difference. Describe the eligibility requirements that prevent those employees not covered by the plan from participating.
4. At any time after December 31, 1959, did any of the following persons engage in any of the transactions listed below with the trust: the creator of the trust or a contributor to the trust; a brother or sister (whole or half blood), a spouse, an ancestor, or a lineal descendant of such a creator or contributor; or a corporation controlled directly or indirectly by such a creator or contributor?

Note: If you know that the organization will be, or is considering being, a party to any of the transactions (or activities) listed below, check the Planned box. Give a detailed explanation of any Yes or Planned answer in the space below.: ----

a. Borrow any part of the trusts income or corpus?
   -- Yes
   -- No
   -- Planned
b. Receive any compensation for personal services?
   -- Yes
   -- No
   -- Planned
c. Obtain any part of the trusts services?
   -- Yes
   -- No
   -- Planned
d. Purchase any securities or other properties from the trust?
   -- Yes
   -- No
   -- Planned
e. Sell any securities or other property to the trust?
   -- Yes
   -- No
   -- Planned
f. Receive any of the trusts income or corpus in any other transaction?
   -- Yes
   -- No
   -- Planned
5. Attach a copy of the Supplemental Unemployment Benefit Plan and related agreements.

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Schedule K Organizations described in section 501(c)(19)A post or organization of past or present members of the Armed Forces of the United States, auxiliary units or societies for such a post or organization, and trusts or foundations formed for the benefit of such posts or organizations.

1. To be completed by a post or organization of past or present members of the Armed Forces of the United States.
   a. Total membership of the post or organization: ----
   b. Number of members who are present or former members of the U.S. Armed Forces: ----
   c. Number of members who are cadets (include students in college or university ROTC programs or at armed services academies only), or spouses, widows, or widowers of cadets or past or present members of the U.S. Armed Forces: ----
   d. Does the organization have a membership category other than the ones set out above?
      -- Yes
      -- No
If Yes, please explain in full. Enter number of members in this category: ----
   1e. If you wish to apply for a determination that contributions to your organization are deductible by donors, enter the number of members from line 1b who are war veterans, as defined below: ----

A war veteran is a person who served in the Armed Forces of the United States during the following periods of war: April 21, 1898, through July 4, 1902; April 6, 1917, through November 11, 1918; December 7, 1941, through December 31, 1946; June 27, 1950, through January 31, 1955; August 5, 1964, through May 7, 1975; and August 2, 1990, through a future date to be set by law or Presidential Proclamation.

2. To be completed by an auxiliary unit or society of a post or organization of past or present members of the Armed Forces of the United States.
   a. Is the organization affiliated with and organized according to the bylaws and regulations formulated by such an exempt post or organization?
      -- Yes
      -- No
If Yes, submit a copy of such bylaws or regulations.
   b. How many members does your organization have?: ----
   c. How many are themselves past or present members of the Armed Forces of the United States, or are their spouses, or persons related to them within two degrees of blood relationship? (Grandparents, brothers, sisters, and grandchildren are the most distant relationships allowable.): ----
   d. Are all of the members themselves members of a post or organization, past or present members of the Armed Forces of the United States, spouses of members of such a post or organization, or related to members of such a post or organization within two degrees of blood relationship?
      -- Yes
      -- No
3. To be completed by a trust or foundation organized for the benefit of an exempt post or organization of past or present members of the Armed Forces of the United States.
   a. Will the corpus or income be used solely for the funding of such an exempt organization (including necessary related expenses)?
      -- Yes
      -- No
If No, please explain.: ----
   b. If the trust or foundation is formed for charitable purposes, does the organizational document contain a proper dissolution provision as described in section 1.501(c)(3)-1(b)(4) of the Income Tax Regulations?
      -- Yes
      -- No


Procedural Checklist

Make sure the application is complete.

If you do not complete all applicable parts or do not provide all required attachments, we may return the incomplete application for the organization to resubmit with the missing information or attachments. This will delay the processing of the application and may delay the effective date of your organizations exempt status. The organization may also incur additional user fees.

Have you...

-- Attached Form 8718 (User Fee for Exempt Organization Determination Letter Request) and the appropriate fee?
-- Prepared the application for mailing? (See Where To File addresses in Form 8718.)
-- Completed all parts and schedules that apply to the organization?
-- Shown your organizations Employer Identification Number (EIN)?
   a. If your organization has an EIN, write it in the space provided.
   b. If this is a newly formed organization and does not have an Employer Identification Number, obtain an EIN. (See Specific Instructions, Part I, Line 2.)
-- If applicable, described your organizations specific activities as directed in Part II, question 1 of the application?
-- Included a conformed copy of the complete organizing instrument? (Part I, question 8 of the application.)
-- Had the application signed by one of the following:
   a. An officer or trustee who is authorized to sign (for example, president, treasurer); or
   b. A person authorized by a power of attorney (submit Form 2848 or other power of attorney)?
-- If applicable, enclosed financial statements (Part III)?
   a. Current year (must include period up to within 60 days of the date the application is filed) and 3 preceding years.
   b. Detailed breakdown of revenue and expenses (no lump sums).
   c. If the organization has been in existence less than 1 year, it must also submit proposed budgets for 2 years showing the amounts and types of receipts and expenditures anticipated.

Note: During the technical review of a completed application, it may be necessary to contact the organization for more specific or additional information.

Do not send this checklist with the application.

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Department of the Treasury
Internal Revenue Service

Instructions for Form 1024 
(Rev. January 2018)
Application for Recognition of Exemption Under Section 501(a).

Section references are to the Internal Revenue Code unless otherwise noted.

Note. Keep a copy of the completed Form 1024 in the organizations permanent records.

Future Developments

For the latest information about developments related to Form 1024 and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form1024.

What's New

If you are an organization such as a civic league, social welfare organization (including certain war veterans' organizations), or local associations of employees applying under section 501(c) (4), dont use Form 1024. Instead, use Form 1024-A, Application for Recognition of Exemption Under Section 501(c)(4) of the Internal Revenue Code.

General Instructions

User fee. When submitting Form 1024, also submit Form 8718, User Fee for Exempt Organization Determination Letter Request, and the user fee called for in Form 8718. You can get Form 8718 and additional forms and publications at IRS.gov. For fee information, see Rev. Proc. 2018-5, 2018-1 I.R.B. 233, available at IRS.gov/irb/201801_IRB, or the latest annual update. For future updates to the user fee, go to IRS.gov/Form1024.

For additional information, see:

 Pub. 557, Tax-Exempt Status for Your Organization;
 Pub. 598, Tax on Unrelated Business Income of Exempt Organizations; and
 IRS.gov/Charities.

Purpose of Form

CAUTION! Dont use Form 1024 if you are an organization applying under Section 501(c)(4). Instead, use Form 1024-A.

Form 1024 is used by most types of organizations to apply for recognition of exemption under section 501(a). See Part I of the application.

Even if these organizations arent required to apply for tax-exempt status, they may wish to file Form 1024 to receive a determination letter of IRS recognition of their section 501(c) status in order to obtain certain incidental benefits such as:

 Public recognition of tax-exempt status,
 Exemption from certain state taxes,
 Advance assurance to donors of deductibility of contributions (in certain cases), and
 Nonprofit mailing privileges, etc.

Note. Generally, Form 1024 isnt used to apply for a group exemption letter. For information on how to apply for a group exemption letter, see Pub. 557.

Note. Tax benefits for certain homeowners associations under section 528 are available to organizations that arent exempt from federal income tax. To elect these benefits, file a properly completed and timely filed (including extensions) Form 1120-H, U.S. Income Tax Return for Homeowners Associations, rather than Form 1024.

What To File

Dont submit any blank schedules that dont apply to your type of organization.

Most organizations applying for exemption under section 501(a) must complete Parts I through III.

Section 501(c)(9), voluntary employees beneficiary associations, and section 501(c)(17), supplemental unemployment benefit trusts, applicants should also complete Part IV.

In addition, each organization must complete the schedule indicated on page 1 of the application for the code section under which it seeks recognition of exemption.

Attachments

For any attachments submitted with Form 1024:

 Show the organizations name, address, and employer identification number (EIN);
 Identify the Part and line item number to which the attachment relates;
 Use 8-  11 inch paper for any attachments; and
 Include any court decisions, rulings, opinions, etc., that will assist us in processing your application. Generally, tape recordings arent acceptable unless accompanied by a transcript.

When To File (Section 501(c)(9) or (17) Organization)

An organization must file Form 1024 to be recognized as an organization described in section 501(c)(9) or 501(c)(17). Generally, if an organization files its application within 15 months after the end of the month in which it was formed, and if the IRS approves the application, the effective date of the organizations section 501(c)(9) or (17) status will be the date it was organized.

Generally, if an organization doesnt file its Form 1024 within 15 months after the end of the month in which it was formed, it wont qualify for exempt status as a section 501(c)(9) or (17) organization during the period before the date of its application. For exceptions and special rules, including automatic extensions in some cases, see Part IV.

The date of receipt is the date of the U.S. postmark on the cover in which an exemption application is mailed or, if no postmark appears on the cover, the date the application is stamped as received by the IRS.

Where To File

U.S. mail. Send the completed Form 1024, user fee payment, and all other required information to:

Internal Revenue Service
Attention: EO Determination Letters
Stop 31
P.O. Box 12192
Covington, KY 41012-0192

Private delivery services. Organizations can use certain private delivery services (PDS) designated by the IRS to meet the timely mailing as timely filing rule for tax returns. Go to IRS.gov/PDS for the current list of PDS.

The private delivery service can tell you how to get written proof of the mailing date.

If you're using PDS, send your application, user fee payment, and all other required information to:

Internal Revenue Service
Attention: EO Determination Letters
Stop 31
201 West Rivercenter Boulevard
Covington, KY 41011

The IRS will determine the organizations tax-exempt status and whether any annual returns must be filed.

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CAUTION! Private delivery services can't deliver items to P.O. boxes. You must use the U.S. Postal Service to mail any items to an IRS P.O. box address.

Signature Requirements

An officer, a trustee who is authorized to sign, or another person authorized by a power of attorney, must sign the Form 1024 application. Attach a power of attorney to the application. You may use Form 2848, Power of Attorney and Declaration of Representative, for this purpose.

After You Submit Form 1024

We will acknowledge receiving your application in writing. You may expect to receive this notice within 21 days of the postmark date of the Form 1024. Read the notice thoroughly because it will provide further information about the processing of your Form 1024.

Generally, we assign applications in the order we receive them. Unless the application is approved for expedited processing, it will be worked in the order received.

No additional information needed. If our review shows that you qualify, we will send you a letter stating that you are exempt under the subsection of section 501(c) that you applied.

Additional information needed. If the review shows that we need additional information or changes, we will call or write you. Examples of the types of questions you may be asked are available at IRS.gov. If the additional information indicates that you qualify, we will send you a letter stating that you are exempt under the subsection of section 501(c) that you applied. If we conclude that you dont qualify for exemption, we will send you a letter that explains our position and your appeal rights.

Language and Currency Requirements

Language requirements. Complete Form 1024 and statements in English. Provide an English translation if the organizational document or bylaws are in any other language. See the conformed copy requirements in the line 8 instructions under Part I. You may be asked to provide English translations of foreign language publications that the organization produces or distributes and that are submitted with the application.

Financial requirements. Report all financial information in U.S. dollars (specify the conversion rate used). Combine amounts from within and outside the United States and report the total for each item on the financial statements.

Example

Gross investment income
From U.S. sources: $4,000
From non-U.S. sources: 1,000
Amount to report on income statement: $5,000

Annual Information Return

If an annual information return is due while the organizations application for recognition of exempt status is pending with the IRS (including any appeal of a proposed adverse determination), the organization should file Form 990, Return of Organization Exempt From Income Tax, or Form 990-EZ, Short Form Return of Organization Exempt From Income Tax, at the following address. Indicate that an application is pending.

Internal Revenue Service
Ogden Service Center
Ogden, UT 84201-0027

The organization may also be eligible to file Form 990-N, Electronic Notice (e-Postcard) for Tax-Exempt Organizations Not Required to File Form 990 or Form 990EZ, available at IRS.gov.

If an organization has unrelated business income of $1,000 or more, file Form 990-T, Exempt Organization Business Income Tax Return.

Applicants under sections 501(c)(5), (9), and (17) should see the Form 990 or Form 990-EZ instructions for special provisions regarding substitutions for certain parts of that form.

Annual Filing Requirements

Certain organizations aren't required to file an information return (Form 990 or Form 990-EZ) or notice (Form 990-N). Generally, organizations not required to file Form 990, or Form 990-EZ, or Form 990-N include churches, certain church affiliated organizations, and certain affiliates of a governmental unit. Note that organizations that are exempt from filing Form 990 or Form 990-EZ because of gross receipts are generally required to submit Form 990-N if they choose not to file Form 990 or Form 990-EZ. For more information, see the Instructions for Form 990 and Form 990-EZ. See IRS.gov for more information.

Public Inspection

Information available for public inspection. If the IRS approves the organizations application for section 501(c) status, the following items will be open to public inspection.

 The complete application and any supporting documents.
 Any correspondence between the organization and the IRS concerning Form 1024, including Form 2848.
 The letter the IRS issues approving your exemption.
 Annual information returns (Form 990, 990-EZ, or 990-N) including schedules, except for the names and addresses of contributors and other identifying information about contributors.

Information not available for public inspection. The following items wont be open for public inspection.

 Any information relating to a trade secret, patent, style of work, or apparatus that, if released, would adversely affect the organization. The IRS must approve withholding this information.
 Any other information that would adversely affect national defense. The IRS must approve withholding this information.
 User fee check.
 Contributors names and addresses and other identifying information about contributors included with Form 990 or Form 990-EZ.
 Form 990-T.

CAUTION! Applicants must identify this information by clearly marking it NOT SUBJECT TO PUBLIC INSPECTION and must attach a statement to explain why the organization asks that the information be withheld. If the IRS agrees, the information will be withheld.

Making documents available for public inspection. Both the organization and the IRS must make the information that is subject to disclosure available for public inspection. The public can request this information by submitting Form 4506-A, Request for Public Inspection or Copy of Exempt or Political Organization IRS Form. The public also may request inspection of the information or a copy of the information directly from you.

An exempt organization may post the documents required to be available for public inspection on its own website. The information return and exemption application materials must be posted exactly as filed with the IRS. Only the information that isnt open for public inspection may be deleted.

If an exempt organization posts the documents on its website, it must provide notice of the website address where the documents may be found, but it need not provide copies of the information. However, documents posted on an organizations website must still be made available for public inspection without charge at its main office during regular business hours.

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Documents arent considered available for public inspection on a website if the otherwise disclosable information is edited or subject to editing by a third party when posted. See Pub. 557 for additional guidance on public inspection.

In the case of organizing documents and bylaws, see the line 8 instructions under Part I.

Specific Instructions

Part I. Identification of Applicant

Line 1. Full name and address of organization. Enter the organizations name exactly as it appears in its organizing documents, including amendments. If the organization will be operating under another name, show the other name in parentheses.

For a foreign address, enter the information in the following order: city, province or state, and country. Follow the countrys practice in placing the postal code in the address. Dont abbreviate the country name.

Line 2. Employer identification number (EIN). All organizations must have an EIN. Enter the nine-digit EIN the IRS assigned to the organization. If the organization doesn't have an EIN, it must apply for one. An EIN can be applied for by visiting the IRS website at IRS.gov/EIN. The organization may also apply for an EIN by faxing or mailing Form SS-4 to the IRS. Organizations outside the United States or U.S. possessions may also apply for an EIN by calling 267-941-1099 (toll call). Dont apply for an EIN more than once.

Line 3. Person to contact. Enter the name and telephone number of the person to be contacted during business hours if more information is needed. The contact person should be an officer, director, or a person with power of attorney who is familiar with the organizations activities and who is authorized to act on its behalf. Attach Form 2848 or other power of attorney.

Line 4. Month the annual accounting period ends. Enter the month the organizations annual accounting period ends. The organizations accounting period is usually the 12-month period that is the organizations tax year. The organizations first tax year depends on the accounting period it chooses. The first tax year could be less than 12 months.

Line 5. Date incorporated or formed. Enter the date the organization became a legal entity. For corporations, this is the date that the articles of incorporation were approved by the appropriate state official. For unincorporated organizations, it is the date its constitution or articles of association were adopted.

Line 6. Indicate if the organization has ever filed Form 1023, Form 1024, or other exemption application with the IRS. If Yes, attach an explanation.

Line 7. Indicate if the organization has ever filed federal income tax returns as a taxable organization or filed returns as an exempt organization (e.g., Forms 990, 990-EZ, 990-N, 990-PF, and 990-T).

Line 8. Type of organization and organizational documents. Organizing instrument. Submit a conformed copy of the organizing instrument. If the organization doesnt have an organizing instrument, it wont qualify for exempt status. A conformed copy is one that agrees with the original and all amendments to it. The conformed copy may be:

 A photocopy of the original signed and dated organizing document; or
 A copy of the organizing document that is unsigned but is sent with a written declaration, signed by an authorized individual, that states that the copy is a complete and accurate copy of the original signed and dated document.

Corporation. A corporation is an entity organized under a federal or state statute, or a statute of a federally recognized Indian tribal or Alaskan native government. A corporation's organizing document is its articles of incorporation.

Certification of filing. If formed under state statute, your articles of incorporation must show certification of filing. This means your articles show evidence that on a specific date they were filed with and approved by an appropriate state authority. The document must be an exact copy of what is on file with your state.

Substitute Articles of Incorporation. If you don't have a copy of your articles of incorporation showing evidence of having been filed and approved by an appropriate state official, you may submit a substitute copy of your articles of incorporation. This substitute copy may be handwritten, typed, printed, or otherwise reproduced. It must be accompanied by a declaration, signed by an officer authorized to sign for you, that it is a complete and correct copy of the articles of incorporation and that it contains all the powers, principles, purposes, functions, and other provisions by which you currently govern yourself.

Unincorporated association. An unincorporated association formed under state law must have at least two members who have signed a written document for a specifically defined purpose. The articles of organization of an unincorporated association must include the name of your organization, your purpose, the date the document was adopted, and the signatures of at least two individuals. If your copy doesn't contain the proper signatures and date of adoption, you may submit a written declaration that states your copy is a complete and accurate copy of the signed and dated original. Your declaration should clearly indicate the original date of adoption.

TIP: Bylaws may be considered an organizing document only if they are properly structured (includes name, purpose, signatures, and intent to form an organization).

Bylaws. "Bylaws" are generally the internal rules and regulations of an organization. If you have bylaws, you should submit a current copy.

Bylaws don't need to be signed unless they are the organizing document described in Unincorporated association above.

Trust. In the case of a trust, a copy of the trustee's or authorized representative's signature and dated trust indenture or agreement must be furnished. Generally, a trust must be funded with property, such as money, real estate, or personal property to be legally created. Enter the date that the trust was funded.

Part II. Activities and Operational Information

Line 2. If its anticipated that the organizations principal sources of support will increase or decrease substantially in relation to the organizations total support, attach a statement describing anticipated changes and explaining the basis for the expectation.

Line 3a. Furnish the mailing addresses of the organizations principal officers, directors, or trustees. Dont give the address of the organization.

Line 3b. The annual compensation includes salary, bonus, and any other form of payment to the individual for services performed for the organization.

Line 4. If your organizations activities were formerly performed under another name or if your organization was a part of another organization (tax-exempt or nonexempt), furnish the requested information. Otherwise, enter N/A.

Line 5. Enter your organizations current or planned connection with any tax-exempt or nonexempt organization.

Line 6. If your organization has issued stock as a means of indicating ownership by its members or others, furnish the

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requested information. Otherwise, enter N/A.

Line 7. If your organization is a membership organization, enter the requested information. Otherwise, enter N/A.

Line 8. If your organization should cease operations as a tax-exempt organization, explain to whom its assets will be distributed.

Line 9. Indicate if the organization distributes, or plans to distribute, any of its property or funds (such as a distribution of profits) to its shareholders or members.

Line 10. Indicate if the organization performs any services for any other organization or individual for which it is paid a fee.

Line 11. Dont include the normal salary of officers or employees.

Line 12. Answer Yes if the organization either provides insurance through a third party or provides the insurance itself.

Line 13. Examples of public regulatory bodies are HUD, HHS, Public Utilities Commission, Housing Commission, and a state insurance commission.

Line 14. Provide the specified information about leased property whether it is used for exempt functions or for other purposes.

Line 15. Provide the specified information about political expenditures whether they were made to support or to oppose particular candidates.

Line 16. This includes any printed material that may be used to publicize the organizations activities or as an informational item to members or potential members.

Part III. Financial Data

The Statement of Revenue and Expenses must be completed for the current year and each of the 3 years immediately before it (or the years the organization has existed, if less than 4).

Any applicant that has existed for less than 1 year must give financial data for the current year and proposed budgets for the following 2 years.

Any applicant that has been in existence more than 1 year but seeks recognition of exemption for only the current year and future years (rather than from the date of its formation) should give financial data for the current year and proposed budgets for the following 2 years.

We may request financial data for more than 4 years if necessary.

All financial information for the current year must cover the period beginning on the first day of the organizations established annual accounting period and ending on any day that is within 60 days of the date of this application.

If the date of this application is less than 60 days after the first day of the current accounting period, no financial information is required for the current year.

Financial information is required for the 3 preceding years regardless of the current year requirements.

Note. If no financial information is required for the current year, the preceding years financial information can end on any day that is within 60 days of the date of this application.

Prepare the statements using the method of accounting and the accounting period the organization uses in keeping its books and records.

If the organization uses a method other than the cash receipts and disbursements method, attach a statement explaining the method used.

A. Statement of Revenue and Expenses

Line 1. Include amounts received from the members that represent the annual dues and any special assessments or initiation fees.

Line 2. Dont include amounts received from the general public or a governmental unit for the exercise or performance of the organizations exempt function.

Line 3. Examples of such income include the income derived by a social club from the sale of food or beverage to its members, the sale of burial lots by a cemetery association, and fees charged by a social welfare organization or trade association for an educational seminar it conducted.

Line 4. Enter the organizations gross income from activities that are regularly carried on and not related to the organizations exempt purposes.

Examples of such income include fees from the commercial testing of products, income from renting office equipment or other personal property, and income from the sale of advertising in an exempt organization periodical. See Pub. 598 for information about unrelated business income and activities.

Line 5. Attach a statement showing the description of each asset, the name of the person to whom sold, and the amount received. In the case of publicly traded securities sold through a broker, the name of the purchaser isnt required.

Line 6. Include the income received from dividends, interest, payments received on securities loans (as defined in section 512(a)(5)), rents, and royalties.

Line 7. Enter the total income from all sources that isnt reported on lines 1 through 6. Include, for example, income from special events (such as raffles and dances) that isnt taxable as unrelated business income. Attach a statement that lists each type of revenue source and the amount derived from each.

Line 9. Enter the expenses directly related to the income sources reported on line 3 of this part.

Line 10. Enter the expenses directly related to the income sources reported on line 4 of this part.

Line 11. Attach a statement showing the name of the recipient, a brief description of the purposes or conditions of payment, and the amount paid.

Line 12. Attach a statement showing the total amount paid for each benefit category, such as disability, death, sickness, hospitalization, unemployment compensation, or strike benefits.

Lines 1318. Use lines 13 through 18 to report expenses that arent directly related to the expense categories listed on lines 9 and 10.

For example, salaries attributable to the organizations exempt purpose activities should be included with any other expenses reportable on line 9 rather than being reported separately on line 14.

Salaries reportable on line 14 include, for example, those attributable to special events, to the solicitation of contributions, and to the overall management and operation of the organization.

Line 13. Attach a statement that shows the name of the person compensated, the office or position, the average amount of time devoted to business per week, month, etc., and the amount of annual compensation.

Line 14. Enter the total of employees salaries not reported on line 13.

Line 15. Enter the total interest expense for the year, excluding mortgage interest treated as occupancy expense on line 16.

Line 16. Enter the amount paid for the use of office space or other facilities; heat, light, power, and other utilities; outside janitorial services; mortgage interest; real estate taxes; and similar expenses.

Line 17. If your organization records depreciation, depletion, and similar expenses, enter the total.

Line 18. Attach a statement listing the type and amount of each significant

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expense for which a separate line isnt provided. Report other miscellaneous expenses as a single total if not substantial in amount.

B. Balance Sheet

Line 1. Enter the total interest and non-interest-bearing cash in checking and savings accounts, temporary cash investments (money market funds, CDs, treasury bills, or other obligations that mature in less than 1 year), change funds, and petty cash funds.

Line 2. Enter the total accounts receivable that arose from the sale of goods and/or performance of services.

Line 3. Enter the amount of materials, goods, and supplies purchased or manufactured by the organization and held to be sold or used in some future period.

Line 4. Attach a statement that shows the name of the borrower, a brief description of the obligation, the rate of return on the principal indebtedness, the due date, and the amount due.

Line 5. Attach a statement listing the organizations corporate stock holdings.

For stock of closely held corporations, the statement should show the name of the corporation, a brief summary of the corporations capital structure, the number of shares held, and their value as carried on the organizations books. If such valuation doesnt reflect current fair market value, also include fair market value.

For stock traded on an organized exchange or in substantial quantities over the counter, the statement should show the name of the corporation, a description of the stock and the principal exchange on which it is traded, the number of shares held, and their value as carried on the organizations books.

Line 6. Attach a statement that shows the borrowers name, purpose of loan, repayment terms, interest rate, and original amount of loan. Report each loan separately, even if more than one loan was made to the same person.

Line 7. Enter the book value of securities held of the U.S., state, or municipal governments. Also enter the book value of buildings and equipment held for investment purposes. Attach a statement identifying each.

Line 8. Enter the book value of buildings and equipment not held for investment. This includes plants and equipment used by the organization in conducting its exempt activities. Attach a statement listing these assets held at the end of the current tax-year period and the cost or other basis.

Line 9. Enter the book value of land not held for investment.

Line 10. Enter the book value of each category of assets not reported on lines 1 through 9. Attach a statement listing each.

Line 12. Enter the total of accounts payable to suppliers and others, such as salaries payable, accrued payroll taxes, and interest payable.

Line 13. Enter the unpaid portion of grants and contributions that the organization has made a commitment to pay to other organizations or individuals.

Line 14. Enter the total of mortgages and other notes payable at the end of the year. Attach a statement that shows each item separately and the lenders name, purpose of loan, repayment terms, interest rate, and original amount.

Line 15. Enter the amount of each liability not reported on lines 12 through 14. Attach a separate statement.

Line 17. Under fund accounting, an organization segregates its assets, liabilities, and net assets into separate funds according to restrictions on the use of certain assets. Each fund is like a separate entity in that it has a self-balancing set of accounts showing assets, liabilities, equity (fund balance), income, and expenses. If the organization uses fund accounting, report the total of all fund balances on line 17.

If the organization doesnt use fund accounting, report only the net assets account balances, such as capital stock, paid-in capital, and retained earnings or accumulated income.

Part IV Notice Requirements

Part IV applies only to section 501(c)(9) and (17) organizations. Organizations applying for tax-exempt status under other sections of the code shouldnt fill in Part IV.

Line 1. If you answer Yes, dont answer questions 2 through 4. If you answer No, go to line 2.

Line 2. Relief from the 15-month filing requirement is granted automatically if the organization submits a completed Form 1024 within 12 months from the end of the 15-month period.

To get this extension, an organization must add the following statement at the top of its application: Filed Pursuant to Section 301.9100-2. No request for a letter ruling is required to obtain an automatic extension.

Line 3. See Regulations sections 301.9100-1 and 301.9100-3 for information about a discretionary extension beyond the 27-month period. Under this regulation, the IRS will allow an organization a reasonable extension of time to file a Form 1024, if it submits evidence to establish that it acted reasonably and in good faith, and granting relief wont prejudice the interests of the government.

Showing reasonable action and good faith. An organization acted reasonably and showed good faith if at least one of the following is true.

 The organization filed its application before the IRS discovered its failure to file.
 The organization failed to file because of intervening events beyond its control.
 The organization exercised reasonable diligence but wasnt aware of the filing requirement. To determine whether the organization exercised reasonable diligence, it is necessary to take into account the complexity of filing and the organizations experience in these matters.
 The organization reasonably relied upon the written advice of the IRS.
 The organization reasonably relied upon the advice of a qualified tax professional who failed to file or advise the organization to file Form 1024. An organization cant rely on the advice of a qualified tax professional if it knows or should know that he or she isn't competent to render advice on filing exemption applications or isnt aware of all the relevant facts.

Not acting reasonably and in good faith. An organization hasnt acted reasonably and in good faith if it chose not to file after being informed of the requirement to file and the consequences of failure to do so. Furthermore, an organization hasnt acted reasonably and in good faith if it used hindsight to request an extension of time to file. That is, if after the original deadline to file passes, specific facts have changed so that filing an application becomes advantageous to an organization, the IRS wont ordinarily grant an extension. To qualify for an extension in this situation, the organization must prove that its decision to file didnt involve hindsight.

No prejudice to the interest of the government. Prejudice to the interest of the government results if granting an extension of time to file to an organization results in a lower total tax liability for the years to which the filing applies than would have been the case if the organization had applied on time. Before granting an extension, the IRS may require the organization requesting it to submit a statement from an independent auditor certifying that no prejudice will result if the extension is granted.

Procedure for requesting extension. To request a discretionary extension, an organization must submit the following with its Form 1024.

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 A statement showing the date Form 1024 should have been filed and the date it was actually filed.
 An affidavit describing in detail the events that led to the failure to apply and to the discovery of that failure. If the organization relied on a qualified tax professionals advice, the affidavit must describe the engagement and responsibilities of the professional and the extent to which the organization relied on him or her.
 All documents relevant to the election application.
 A dated declaration, signed by an individual authorized to act for the organization, that includes the following statement: Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and, to the best of my knowledge and belief, the request contains all the relevant facts relating to the request, and such facts are true, correct, and complete. The individual who signs for the organization must have personal knowledge of the facts and circumstances at issue.
 A detailed affidavit from individuals having knowledge or information about the events that led to the failure to make the application and to the discovery of that failure. These individuals include accountants or attorneys knowledgeable in tax matters who advised the organization concerning the application. Any affidavit from a tax professional must describe the engagement and responsibilities of the professional as well as the advice that the professional provided to the organization. The affidavit also must include the name, current address, and taxpayer identification number of the individual making the affidavit (the affiant). The affiant also must forward with the affidavit a dated and signed declaration that states: Under penalties of perjury, I declare that I have examined this request, including accompanying documents, and, to the best of my knowledge and belief, the request contains all the relevant facts relating to the request, and such facts are true, correct, and complete.

The reasons for late filing should be specific to your particular organization and situation. Regulations section 301.9100-3 lists the factors the IRS will consider to determine if good cause exists for granting a discretionary extension of time to file the application. To address these factors your response on line 3 should provide the following information.

 Whether the organization consulted an attorney or accountant knowledgeable in tax matters, or communicated with a responsible IRS employee (before or after the organization was created), to ascertain the organizations federal filing requirements and, if so, the names and occupations or titles of the persons contacted, the approximate dates, and the substance of the information obtained.
 How and when the organization learned about the 15-month deadline for filing Form 1024.
 Whether any significant intervening circumstances beyond the organizations control prevented it from submitting the application timely or within a reasonable period of time after it learned of the requirement to file the application within the 15-month period.
 Any other information that you believe may establish reasonable action and good faith and no prejudice to the interest of the government for not filing timely or otherwise justify granting the relief sought.

A request for relief under this section is treated as part of the request for the exemption determination letter and is covered by the user fee submitted with Form 8718.

Line 4. If you answer No, the organization may receive an adverse letter limiting the effective date of its exempt status to the date its application was received.

Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. If you want your organization to be recognized as tax exempt by the IRS, you are required to give us this information. We need it to determine whether the organization meets the legal requirements for tax-exempt status.

The organization isnt required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The rules governing the confidentiality of the Form 1024 application are covered in section 6104.

The time needed to complete and file this form will vary depending on individual circumstances.

The estimated average times are:

Taxpayer Burden for Exempt Organizations

Note: In this table, columns follow each other in this order: Form 1024; Recordkeeping; Learning about the law or the form; Preparing and sending the form to the IRS.

Parts IIII; 26 hr., 1 min.; 3 hr., 2 min.; 5 hr., 35 min..
Part IV; 1 hr., 40 min.; 47 min.; 51 min..
Sch. A; 2 hr., 52 min.; 18 min.; 21 min..
Sch. C; 57 min.; 12 min.; 13 min..
Sch. D; 4 hr., 4 min.; 18 min.; 22 min..
Sch. E; 1 hr., 40 min.; 18 min.; 20 min..
Sch. F; 2 hr., 23 min.; 6 min.; 8 min..
Sch. G; 1 hr., 54 min.; 6 min.; 7 min..
Sch. H; 1 hr., 40 min.; 6 min.; 7 min..
Sch. I; 5 hr., 30 min.; 30 min.; 36 min..
Sch. J; 2 hr., 23 min.; 6 min.; 8 min..
Sch. K; 3 hr., 21 min.; 6 min.; 9 min..

Comments and suggestions. If you have comments concerning the accuracy of these time estimates or suggestions for making Form 1024 simpler, we would be happy to hear from you.

You can send us comments from IRS.gov/FormComments.

Or you can write to the

Internal Revenue Service
Tax Forms and Publications Division
1111 Constitution Ave. NW, IR-6526
Washington, DC 20224

Don't send Form 1024 to this address. Instead, see Where To File, earlier.

The end of Form 1024 and Instructions.