
Form 1024-A and Instructions 
Application for Recognition of Exemption
Under Section 501(c)(4) of the Internal Revenue Code
(January 2018)
Cat. No. 69155Y

Provided by the:
Internal Revenue Service
Alternative Media Center

In 1 File
Print pages 1-4 and 1-7

Contents

Section:  Page
Form 1024-A:  1
   Part I. Identification of Applicant:  1
   Part II. Organizational Structure:  1
   Part III. Narrative Description of Your Activities:  1
   Part IV. Part IV.  Officers, Directors, Trustees, Employees, and Independent Contractors:  2
   Part V. Your Specific Activities:  2
   Part VI. Financial Data:  3
   Part VII. Annual Filing Requirements (see instructions):  4
   Part VIII. Information Regarding Notification Requirement Under Section 506:  4
   Part IX. User Fee Information and Signature:  4
Instructions for Form 1024-A:  1
   Future Developments:  1
   General Instructions:  1
   Purpose of Form:  1
   What To File:  1
   Attachments:  1
   Where To File:  1
   Private Delivery Service:  1
   Signature Requirements:  1
   After You Submit Form 1024-A:  1
   Language and Currency Requirements:  2
   Annual Information Return:  2
   Public Inspection:  2
   Specific Instructions:  2
   Part I. Identification of Applicant:  2
   Part II. Organizational Structure:  3
   Type of Organization and Organizational Documents:  3
   Part III. Activities:   3
   Part IV. Officers, Directors, Trustees, Employees, and Independent Contractors:  3
   Part V. Your Specific Activities:  4
   Part VI. Financial Data:  4
   A. Statement of Revenue and Expenses:  4
   B. Balance Sheet:   5
   Part VII. Annual Filing Requirements:   5
   Part IX. User Fee Information and Signature:  6
   Paperwork Reduction Act Notice:  6
   Procedural Checklist:  7

This electronic edition contains the entire text of the print editions.

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Form 1024-A
Application for Recognition of Exemption
Under Section 501(c)(4) of the Internal Revenue Code
(January 2018)

Go to www.irs.gov/Form1024A for instructions and the latest information.

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

Complete Parts I-IX and submit Form 8718 (with payment of the appropriate user fee). Attach additional sheets if you need more space to answer fully. Use the instructions to complete this application and for definitions of terms used in this form. For additional help, call IRS Exempt Organizations Customer Account Services toll-free at 877-829-5500, or visit our website at www.irs.gov. If you don't submit the required information, we may return the application to you. A request for a determination under section 501(c)(4) is optional. See instructions for additional information.

Don't include social security numbers on this form as it may be made public.

Part I. Identification of Applicant
1. Full name of organization (exactly as it appears in your organizing document): ----
2. c/o Name (if applicable): ----
3. Mailing address (Number and street) (see instructions): ----
   City or town, state or country, and ZIP + 4: ----
4. Employer Identification Number (EIN): ----
5. Month the annual accounting period ends: ----
6. Primary contact (officer, director, trustee, or authorized representative)
   a. Name: ----
   b. Phone: ----
   c. Fax (optional): ----
7. Organization's website: ----

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. Don't 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. -- Yes, -- No
2. 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. Include copies of any amendments to your articles and be sure they show state filing certification. Also, if you adopted an operating agreement, attach a copy, along with any amendments. -- Yes, -- No
3. 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
4. Are you a trust? If "Yes," attach a signed and dated copy of your trust agreement. Include signed and dated copies of any amendments. If you are a trust, enter the date the trust was funded. (MM/DD/YYYY) -- Yes, -- No, ----
5. Have you adopted bylaws? If "Yes," attach a current copy showing date of adoption. If "No," explain in an attachment how your officers, directors, or trustees are selected. -- Yes, -- No

Part III. Narrative Description of Your Activities

Use an attachment to describe all of your past, present, and planned activities in a narrative (including the percentage of time and funds spent on these activities). You may attach representative copies of newsletters, brochures, or similar documents for supporting details to this narrative. Refer to the instructions for information that must be included in your description. Check this box to confirm that you submitted a narrative attachment describing your activities. --

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Name: ----
EIN: ----

Part IV. Officers, Directors, Trustees, Employees, and Independent Contractors

1. List the names, titles, and mailing addresses for all of your officers, directors, and trustees. If additional space is needed, attach a separate sheet.

Note: In this table, columns follow each other in this order: Name: Title; Mailing address.

----: ----; ----
----: ----; ----
----: ----; ----

The following "Yes" or "No" questions relate to all past, present, or planned relationships, transactions, or agreements with your officers, directors, trustees, employees, members, and independent contractors.

2. Do you have a family or business relationship or agreement with any of your officers, directors, trustees, employees, members, or independent contractors, or any entity they own or control, other than through their position as your officer, director, trustee, employee, member, or independent contractor? If "Yes," identify in an attachment the individual and describe the relationship or agreement. -- Yes, -- No
3a. Do or will you pay any compensation to your officers, directors, trustees, employees, members, or independent contractors? If "Yes," answer lines 3b and 3c. -- Yes, -- No
b. Do or will the individuals that approve compensation arrangements follow a conflict of interest policy? If "No," describe in an attachment how you set compensation that is reasonable. -- Yes, -- No
c. Do or will you compensate any of your officers, directors, trustees, employees, members, or independent contractors through nonfixed payments, such as discretionary bonuses or revenue-based payments? If "Yes," describe in an attachment all nonfixed compensation agreements. -- Yes, -- No

Part V. Your Specific Activities

The following "Yes" or "No" questions relate to all past, present, and planned activities you may conduct. See instructions.

1. 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? If "Yes," explain in detail and list the amounts spent or to be spent in each case in an attachment. -- Yes, -- No
2. Have you previously received a ruling or determination letter recognizing you (or any predecessor organization) as exempt under section 501(c)(3) and later revoked that recognition of exemption on the basis that you (or your predecessor) were carrying on propaganda or otherwise attempting to influence legislation or on the basis that it engaged in political activity? If "Yes," explain in an attachment. -- Yes, -- No
3. Are you a successor to another organization? Answer "Yes" if you have taken or will take over the activities of another organization, you took over 25% or more of the fair market value of the net assets of another organization, or you were established upon the conversion of an organization from for-profit to nonprofit status. If "Yes," explain in an attachment. -- Yes, -- No
4. Are you connected in any way with any other organization (for example, financial support on a continuing basis; shared facilities or employees; same officers, directors, or trustees)? If "Yes," explain in an attachment. -- Yes, -- No
5. Do you have members? If "Yes," state in an attachment the qualifications necessary for membership, the classes of membership and number of members in each class, and the voting rights or privileges received. -- Yes, -- No
6. Have you made, or do you plan on making, any distribution of property or surplus funds to shareholders or members? If "Yes," explain in an attachment. -- Yes, -- No
7. Do you receive payments for services performed? If "Yes," explain in an attachment the services performed, income realized and expenses incurred, and the nature of benefits to the general public from these activities. -- Yes, -- No
8. Do you lease property? If "Yes," explain in an attachment. Include a description of the property, any relationship between the applicant and the other party, and a copy of the lease agreement. -- Yes, -- No
9. Are you a homeowner's association? If "Yes," explain in an attachment whether access to any property or facility you own or maintain is restricted in any way. -- Yes, -- No
10. Are you a local association of employees? If "Yes," state in an attachment the name and address of each employer whose employees are eligible for membership in the organization. -- Yes, -- No
11. Do you or will you make foreign grants or conduct activities in any foreign country or countries? If "Yes," describe those grants or activities in an attachment. -- Yes, -- No

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Name: ----
EIN: ----

Part VI. Financial Data

(see instructions for information you must provide) (attach statement regarding accounting method, if necessary)

A. Statement of Revenues and Expenses

Revenues

Note: In this table, columns follow each other in this order: Type of revenue or expense: Year ----; Year ----; Year ----

1. Gifts, grants, and contributions received: ----; ----; ----
2. Membership fees received: ----; ----; ----
3. Gross investment income: ----; ----; ----
4. Net unrelated business income: ----; ----; ----
5. Taxes levied for your benefit: ----; ----; ----
6. Value of services or facilities furnished by a governmental unit without charge: ----; ----; ----
7. Any revenue not otherwise listed above or in lines 9-11 below (attach statement): ----; ----; ----
8. Total of lines 1 through 7: ----; ----; ----
9. Gross receipts from any activity that is related to your exempt purposes: ----; ----; ----
10. Total of lines 8 and 9: ----; ----; ----
11. Net gain or loss on sale of capital assets (attach statement): ----; ----; ----
12. Total Revenue. Combine lines 10 and 11: ----; ----; ----

Expenses

Note: In this table, columns follow each other in this order: Type of revenue or expense: Year ----; Year ----; Year ----

13. Fundraising expenses (attach statement): ----; ----; ----
14. Contributions, gifts, grants, and similar amounts paid out (attach statement): ----; ----; ----
15. Disbursements to or for the benefit of members (attach statement): ----; ----; ----
16. Compensation of officers, directors, and trustees: ----; ----; ----
17. Other salaries and wages: ----; ----; ----
18. Occupancy: ----; ----; ----
19. Any expense not otherwise classified, such as program services (attach statement): ----; ----; ----
20. Total Expenses. Add lines 13 through 19: ----; ----; ----

B. Balance Sheet (for your most recently completed tax year)
Assets: Year End
1. Cash: ----
2. Accounts receivable, net: ----
3. Inventories: ----
4. Bonds and notes receivable (attach statement): ----
5. Corporate stocks (attach statement): ----
6. Loans receivable (attach statement): ----
7. Other investments (attach statement): ----
8. Depreciable and depletable assets (attach statement): ----
9. Land: ----
10. Other assets (attach statement): ----
11. Total assets (add lines 1 through 10): ----

Liabilities: Year End
12. Accounts payable: ----
13. Contributions, gifts, grants, etc., payable: ----
14. Mortgages and notes payable (attach statement): ----
15. Other liabilities (attach statement): ----
16. Total liabilities (add lines 12 through 15): ----

Fund Balances or Net Assets: Year End
17. Total fund balances or net assets: ----
18. Total liabilities and fund balances or net assets (add lines 16 and 17): ----

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Name: ----
EIN: ----

Part VII. Annual Filing Requirements (see instructions)
Certain organizations aren't required to file an information return. If you are granted tax-exemption, are you claiming to be excused from filing an information return? If "Yes," explain in an attachment. -- Yes, -- No

If you fail to file a required information return for three consecutive years, your exempt status will be revoked.

Part VIII. Information Regarding Notification Requirement Under Section 506

Most organizations operating under section 501(c)(4) are required to notify the IRS that they are operating under section 501(c)(4) within 60 days of formation by filing Form 8976, Notice of Intent to Operate Under Section 501(c)(4). If an organization doesn't submit a timely notification, a penalty will be assessed. Submission of Form 1024-A doesn't satisfy the requirement to provide notice to the IRS. See instructions for additional information regarding the notification requirement.

Part IX. User Fee Information and Signature

You must include Form 8718 and the correct user fee payment with this application. If you don't submit the correct user fee, we won't process the application and we will return it to you. Your check or money order must be made payable to the United States Treasury. User fees are subject to change. Check our website at www.irs.gov and type "User Fee" in the keyword box, or call Customer Account Services at 877-829-5500 for current information. Also, attach Form 2848, if the application is signed by a person authorized by power of attorney.

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 of Officer, Director, Trustee, or other authorized individual): ----
(Type or print name of signer): ----
(Type or print title or authority of signer): ----
(Date): ----

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Instructions for Form 1024-A
Application for Recognition of Exemption Under Section 501(c)(4) of the Internal Revenue Code
(January 2018)

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

Note. Keep a copy of the completed Form 1024-A in the organization's permanent records.

Future Developments

For the latest information about developments related to Form 1024-A and its instructions, such as legislation enacted after they were published, go to IRS.gov/Form1024A.

General Instructions

User fee. Along with Form 1024-A, also submit Form 8718, User Fee for Exempt Organization Determination Letter Request, and the user fee called for in the 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/2018-01_IRB, or latest annual update. For information on future updates to the user fee, go to IRS.gov/Form1024A.

Helpful information. 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

Form 1024-A is used by organizations to apply for recognition of exemption under section 501(c)(4).

Section 501(c)(4) organizations aren't required to file Form 1024-A to be tax-exempt, except as described below. However, organizations may wish to file Form 1024-A to receive a determination letter of IRS recognition of their section 501(c)(4) status in order to obtain certain incidental benefits such as:

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

Organizations that have been auto-revoked are required to apply for reinstatement, even if they were not required to apply for tax-exempt status initially. See Rev. Proc. 2014-11, 2014-3 I.R.B. 441 at IRS.gov/irb/2014-3_IRB.html. As such, these organizations are required to file Form 1024-A.

Note. Most organizations operating under section 501(c)(4) are required to notify the IRS that they are operating under section 501(c)(4) within 60 days of formation by filing Form 8976 (see Rev. Proc. 2016-41, 2016-30 I.R.B. 165 at IRS.gov/irb/2016-30_IRB/ar09). This requirement isn't met by submitting Form 1024-A, requesting recognition of exemption under section 501(c)(4).

Note. Generally, Form 1024-A isn't 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 aren't 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, instead of Form 1024-A.

What To File

Attachments

For any attachments submitted with Form 1024-A:

 Show the organization's name, address, and employer identification number (EIN);
 Identify the part and line item number to which the attachment relates;
 Use 8-1/2 by 11 inch paper for any attachments; and
 Include any court decisions, rulings, opinions, etc., that will assist us in processing your application. Generally, attachments in the form of tape recordings aren't acceptable unless accompanied by a transcript.

Where To File

File the completed Form 1024-A application, 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

The IRS will determine the organization's tax-exempt status and whether any annual returns must be filed.

Private Delivery Service

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 list of PDS.

The PDS can tell you how to get written proof of the mail date. If you're using PDS, send your application, user fee and all other required information to:

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

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, director, or trustee who is authorized to sign, or another person authorized by a power of attorney, must sign the Form 1024-A 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-A

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-A. Read the notice thoroughly because it will provide further information about the processing of your Form 1024-A.

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 section 501(c)(4).

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.

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If the additional information indicates that you qualify, we will send you a letter stating that you are exempt under section 501(c)(4). If we conclude that you do not 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-A and its 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 instructions under Part II. 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 organization's 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 the 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 990-EZ, 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.

Public Inspection

Information available for public inspection. If the IRS approves the organization's application for section 501(c)(4) 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-A, 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 won't 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 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 may also 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 isn't 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 organization's website must still be made available for public inspection without charge at its main office during regular business hours.

Documents aren't 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 instructions under Part II.

Specific Instructions

Part I. Identification of Applicant

Line 1. Full name of organization. Enter the organization's 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.

Line 2. c/o Name. If you have an "in care of" name, enter it here.

Line 3. Mailing address. Enter your complete address where all correspondence will be sent. If mail is not delivered to the street address and you have a P.O. Box, show the box number instead of the street address.

For a foreign address, enter the information in the following order: city, province or state, and country. Follow the country's practice in placing the postal code in the address. Don't abbreviate the country name.

Line 4. 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). Don't apply for an EIN more than once.

Line 5. Month the annual accounting period ends. Enter the month the organization's annual accounting period ends. The organization's accounting period is usually the 12-month period that is the organization's tax year. The organization's first tax year depends on the accounting period it chooses. The first tax year could be less than 12 months.

Lines 6a, b, and c. Person to contact. Enter the name and telephone number of the person to be contacted during business hours if more information is needed.

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The contact person should be an officer, director, or a person with power of attorney who is familiar with the organization's activities and who is authorized to act on its behalf. Attach Form 2848 or other power of attorney.

Line 7. Organization's website. Enter your complete website address if you have one. Also, list any websites maintained on your behalf. The information on your website should be consistent with the information in your Form 1024-A.

Part II. Organizational Structure

Type of Organization and Organizational Documents

Organizing instrument. Submit a conformed copy of the organizing instrument. If the organization doesn't have an organizing instrument, it won't 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.

CAUTION! If you file Form 1024-A within 27 months after the end of the month in which you were legally formed, and we approve the application, the legal date of formation will be the effective date of your exempt status. If you do not file Form 1024-A within 27 months of formation, you may not qualify for exempt status before the date we receive Form 1024-A. The date considered to be the date we receive Form 1024-A is generally the postmark date.

Line 1. 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.

Line 2. Limited Liability Company (LLC). In the case of a limited liability company, the state approved articles of organization must be submitted along with the operating agreement if one has been adopted. For more information on requirements for LLCs applying for recognition of exemption, see IRS.gov.

Line 3. 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).

Line 4. Trust. In the case of a trust, a copy of the signed and dated trust instrument 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.

Line 5. 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 as described in Line 3 above.

Part III. Activities 

Describe completely and in detail your past, present, and planned activities. Do not refer to or repeat the purposes in your organizing document. You may refer to other parts of the application rather than repeat information provided elsewhere.

For each past, present, or planned activity, include information that answers the following questions.

 What is the activity?
 Who conducts the activity?
 Where is the activity conducted (for example, Los Angeles and San Francisco, California)?
 How does the activity further your exempt purposes?
 What percentage of your total time is allocated to the activity?
 How is the activity funded? (This should agree with the financial data in Part VI.)
 List any alternate names under which you operate, including any "aka" (also known as) or "dba" (doing business as) names.

If you have a website, you may attach a print out of your website page to support your narrative description of activities.

Part IV. Officers, Directors, Trustees, Employees, and Independent Contractors

Line 1. Enter the name, title, and mailing addresses of the organization's principal officers, directors, or trustees. Don't give the address of the organization.

Line 2. Describe business relationships between the organization and any of your officers, directors, trustees, employees, members, or independent contractors other than their position with you as an officer, director, trustee, employee, member, or independent contractor. Describe family or business relationships between your officers, directors, trustees, employees, members, or independent contractors other than their position with you as an officer, director, trustee, employee, member, or independent contractor.

 "Family relationships" include the individual's spouse, ancestors, children, grandchildren, great-grandchildren, siblings (whether by whole or half blood), and the spouses of children, grandchildren, great-grandchildren, and siblings.
 "Business relationships" include employment and contractual relationships, and common ownership of a business where any officers, directors, or trustees, individually or together, possess more than a 35% ownership interest in common. "Ownership" means voting power in a corporation, profits interest in a partnership, or beneficial interest in a trust.

Line 3a. Answer each item with information about compensation paid to your officers, directors, trustees, employees, members, or independent contractors.

Line 3b. A "conflict of interest" arises when a person in a position of authority over an organization, such as a director, officer, or manager, may benefit personally from a decision he or she could make.

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Adoption of a conflict of interest policy is not required to obtain tax-exempt status. However, by adopting a policy, you will be choosing to put in place procedures that will help you avoid the possibility that those in positions of authority may receive an inappropriate benefit.

"Reasonable compensation" is the amount that would ordinarily be paid for like services by like organizations under like circumstances as of the date the compensation arrangement is made. Establishing and documenting reasonable compensation is important because excessive compensation may result in excise taxes on both the individual and the organization. In addition, this may jeopardize the organization's tax exemption.

Line 3c. A "fixed payment" means a payment that is either a set dollar amount or fixed through a specific formula where the amount doesn't depend on discretion. For example, a base salary of $200,000 that is adjusted annually based on the increase in the Consumer Price Index is a fixed payment.

A "non-fixed payment" means a payment that depends on discretion. For example, a bonus of up to $100,000 that is based on an evaluation of performance by the governing board is a non-fixed payment because the governing body has discretion over whether the bonus is paid and the amount of the bonus.

Part V. Your Specific Activities

Line 1. Provide the specified information about political expenditures whether they were made to support or to oppose particular candidates.

Line 2. If your organization (including any predecessor organization) lost its section 501(c)(3) status due to carrying on propaganda or otherwise attempting to influence legislation or due to participating in, or intervening in, any political campaign on behalf of (or in opposition to) any candidate for public office, then your organization will not be treated as an organization described in section 501(c)(4). This rule will not apply if your organization was a church or church-affiliated organization described in section 501(h)(5) in the tax year immediately preceding the tax year in which section 501(c)(3) status was lost.

Line 3. You are a "successor" if you have:

 Substantially taken over all of the assets or activities of another organization;
 Been converted or merged from another organization; or
 Installed the same officers, directors, or trustees as another organization that no longer exists and that had purpose(s) similar to your purpose(s).

Line 4. Indicate your organization's current or planned connection with any tax-exempt or nonexempt organization.

Line 5. If your organization is a membership organization, submit the requested information.

Line 6. 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 7. Indicate if the organization performs any services for any other organization or individual for which it received a fee.

Line 8. Provide the specified information about leased property whether it is used for exempt functions or for other purposes.

Line 9. Answer "Yes" if the organization is a membership organization formed to own and maintain common green areas, streets, and sidewalks and to enforce covenants to preserve the appearance of the development.

Line 10. Answer "Yes" if the organization's membership is limited to employees of a designated person or persons in a particular municipality and whose net earnings will be devoted exclusively to charitable, educational, or recreational purposes.

Line 11. A "foreign country" is a country other than the United States, its territories and possessions, and the District of Columbia.

In describing your grants or activities, include the answers to the following questions.

 In which countries do you plan to make grants or conduct activities?
 What practices and procedures do you have in place to ensure that foreign expenditures or grants are not diverted to support terrorism or other non-exempt activities?
 If you plan to distribute funds or goods, what funds or goods have been or will be distributed and for what purposes?
 How do you process grant requests, including your application, review, and approval process for the grant requests you receive?
 How do you ensure the funds or goods are used for the intended purposes?

Part VI. Financial Data

The Statement of Revenue and Expenses must be completed for the current year and each of the 2 years immediately before it (or the years the organization has existed, if less than 3).

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 only for 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 3 years if necessary.

All financial information for the current year must cover the period beginning on the first day of the organization's 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 2 preceding years regardless of the current year requirements.

Note. If no financial information is required for the current year, the preceding year's 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 funds or other items of value that you receive as gifts, grants, or contributions.

Line 2. Include amounts received from members to provide support to the organization. Do not include payments from members or on behalf of members to purchase admissions, merchandise, services, or use of facilities.

Line 3. Include gross income from dividends, interest, payments received on securities, loans, rents, and royalties that are held for investment purposes.

Line 4. Net income from unrelated business activities generally includes income from any trade or business activity that is regularly carried on, not conducted with substantially all (at least 85%) volunteer labor, and not related to your exempt purposes. (This amount can be taken from Form 990-T, if filed.)

See Pub. 598 for additional information regarding unrelated business income.

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Line 5. Include the amount collected by any local tax authority from the public on your behalf.

Line 6. To determine the value of services or facilities furnished by a governmental unit, use the fair market value of the services or facilities furnished to you. Do not include the value of services or facilities generally provided to the public without charge.

Line 7. Enter the total income from all sources not reported on lines 1 through 6, or lines 9 and 11. Submit an itemized list showing each type and amount of income included on this line. Also, briefly describe each type of income.

Line 8. Add lines 1 through 7 and enter the amount.

Line 9. "Gross receipts" is income from activities that you conduct to further your exempt purposes (excluding amounts listed on other lines). It includes payments by a governmental unit that may be called a "grant," but that is actually payment for a service or facility for the use of the government payer, rather than for the direct benefit of the public.

Line 10. Add lines 8 and 9 and enter the amount.

Line 11. Attach a schedule with total amounts entered (rather than each individual transaction) for each category.

Line 12. Combine lines 10 and 11 and enter the amount.

Line 13. Fundraising expenses include the total expenses incurred by you for soliciting gifts, grants, and contributions included on line 1. Where you allocate a portion of your other expenses to fundraising, submit an itemized list describing the amounts allocated. Include fees paid to professional fundraisers for soliciting gifts, grants, and contributions.

Line 14. If distributions have been made, submit an itemized list showing the name of each recipient, a brief description of the purposes or conditions of payment, and the amount paid.

Line 15. If payments have been made, submit an itemized list showing the name of each recipient, a brief description of the purposes or condition of payment, and amount paid. Do not include any amounts on line 14.

Line 16. Enter the total amount of compensation. Be consistent with information provided in Part IV, lines 3a, 3b, and 3c.

Line 17. Enter the total amount of employees' salaries and wages not reported on line 16 above.

Line 18. 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 19. Submit an itemized list showing the type and amount of each significant expense for which a separate line is not provided.

Line 20. Add lines 13 through 19 and enter the amount on line 20.

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 schedule 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 schedule listing the organization's corporate stock holdings.

For stock of closely held corporations, the schedule should show the name of the corporation, a brief summary of the corporation's capital structure, the number of shares held, and their value as carried on the organization's books. If such valuation doesn't 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 schedule 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 organization's books.

Line 6. Attach a schedule that shows the borrower's 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 U.S., state, or municipal government securities held. Also enter the book value of buildings and equipment held for investment purposes. Attach a schedule identifying each.

Line 8. Enter the book value of buildings and equipment not held for investment. This includes plant and equipment used by the organization in conducting its exempt activities. Attach a schedule 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 schedule listing each.

Line 11. Add lines 1 through 10 and enter the amount on line 11.

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 schedule that shows each item separately and the lender's 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 schedule.

Line 16. Add lines 12 through 15 and enter the amount on line 16.

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 doesn't use fund accounting, report only the "net assets" account balances, such as capital stock, paid-in capital, and retained earnings or accumulated income.

Line 18. Add lines 16 and 17 and enter the amount on line 18.

Part VII. 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.

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Part IX. User Fee Information and Signature

An officer, director, or trustee who is authorized to sign, or another person authorized by a power of attorney, must sign the Form 1024-A application. Attach a power of attorney to the application. You may use Form 2848 for this purpose. The signature must be accompanied by the title or authority of the signer and the date. Please type or clearly print the accompanying information.

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 isn't 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-A 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:

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

Parts I-III: 4 hr., 4 min.; ----; 4 min.
Parts IV-VII: 12 hr., 40 min.; 40 min.; 2 hr., 5 min.

Comments and suggestions. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from IRS.gov/FormComments. Or you can send your comments to Internal Revenue Service, Tax Forms and Publications Division, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Don't send Form 1024-A to this address. Instead, see Where To File, earlier.

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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 organization's 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 of the application?
-- Shown your organization's 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.
-- If applicable, described your organization's specific activities as directed in Part III of the application?
-- Included a conformed copy of the complete organizing instrument? (Part II 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 VI)?
   a. Current year (must include period up to within 60 days of the date the application is filed) and 2 preceding years. If the organization has been in existence less than 1 year, it must submit proposed budgets for 2 years showing the amounts and types of receipts and expenditures anticipated.
   b. Detailed breakdown of revenue and expenses (no lump sums).

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.

End of Form 1024-A and Instructions
