Request For Exemption - State Of Michigan

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CTS - 03
State of Michigan
AUTHORITY 1975 PA 169
Department of Attorney General
1961 PA 101
PENALTY: civil, criminal
REQUEST FOR EXEMPTION
Charitable Organizations and Solicitations Act (COSA)
Supervision of Trustees for Charitable Purposes Act (STCPA)
Complete this form to request exemption from the two laws listed above. Some exemptions apply to both laws.
Although you may be exempt from registration under COSA, registration may be required under STCPA and vice
versa.
PLEASE TYPE OR PRINT IN INK – Attach additional pages if more space is needed.
Legal Name of Organization
Attorney General File # (CS/CT/T) if applicable
Address of Organization
City
County
State
Zip
Area Code
Telephone Number
Organization Email Address
Website
Organization Fax Number
Other names used by organization
Employer Identification Number (EIN)
GENERAL INFORMATION
A. Type of Organization
Check one.
Nonprofit corporation –
State of incorporation ________
Date incorporated _______________
If incorporated in Michigan, enter your Corporate Identification Number: __________________
Provide copies of your articles of incorporation, bylaws and, if applicable, Mich. Certificate of Authority.
Trust –
Provide a copy of the trust instrument.
Unincorporated Association –
Provide a copy of your Articles of Association, Constitution and Bylaws, or other organizing document.
Other –
explain and provide a copy of the relevant document:
B. Organization's Federal Tax Exempt Status
Check one.
Exempt under 501(c)(3) -
Provide a copy of your determination letter.
Applied, or will apply, for tax exempt status under section 501(c)___.
Date of application. ________________
If you checked either box above, indicate the form used to apply for exempt status.
Form 1023-EZ
Form 1023
Exempt under another section: Section 501(c) ____
Provide a copy of your determination letter.
The organization is not tax exempt and will not apply for tax exempt status.
Explain:_____________________________
C. Summarize the organization's purpose in 50 words or less. Do not simply refer to articles of incorporation or quote required
IRS language.
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