2
Form 8871 (7-2000)
Page
Part IV
List of All Officers, Directors, and Highly Compensated Employees (see instructions)
9a
Name
9b
Title
9c
Address
Under penalties of perjury, I declare that the organization named in Part I is to be treated as an organization described in section 527 of the Internal
Revenue Code, and that I have examined this notice, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and complete.
Sign
Signature of authorized official
Date
Here
8871
Form
(7-2000)