Application For Exemption - Secretary Of State Page 2
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26.
Organization's Purpose Category
Complete either Section 1 or Section 2 below.
Section 1: Enter up to three NTEE (National Taxonomy of Exempt Entities) Codes here:
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Section 2: Check up to three boxes below that best describe your organization:
A. Arts, Culture, Humanities
L. Housing, Shelter
T. Philanthropy, Volunteerism,
(inc. historical)
(inc. senior citizen housing)
Grant-making (inc. foundations)
B. Educational Institutions
M. Public Safety, Disaster
U. Science and Technology
(inc. literacy)
Preparedness and Relief
Research Institutes
C. Environment, Beautification
(inc. rescue squads, auto safety)
(inc. computer science, engineering)
(inc. gardening, outdoor education)
N. Recreation, Sports, Leisure,
V. Social Sciences Institutes
D. Animal-Related
Athletics
(inc. institutes for studies on population,
(inc. wildlife sanctuaries)
(inc. social clubs, Special Olympics)
minorities and economics)
E. Health-General, Rehabilitative
O. Youth Development
W. Public Affairs, Society Benefit
(inc. nursing, family planning)
P. Human Services
(inc. citizen participation, con-
F. Mental Health, Crisis Intervention
(inc. thrift stores, YMCAs and YWCAs,
sumer protection, veterans'
(inc. alcoholism, services for rape and abuse
hearing- or sight-impaired orgs.)
orgs., leadership development)
victims)
Q. International, Foreign Affairs,
X. Religion, Spiritual Development
G. Disease, Disorders, Medical Disciplines
National Security (inc. cultural
(inc. religious broadcasters and
H. Medical Research
exchange)
interfaith coalitions)
Y. Mutual / Membership Benefit
I. Crime, Legal-Related
R. Civil Rights, Social Action,
(inc. prevention of abuse, delinquency)
Advocacy (inc. right to life and
(inc. fraternal organizations,
right to die, reproductive rights)
cemeteries)
J. Employment, Job-Related
Z. Unknown, Other
(inc. voc. rehabilitation, unions)
S. Community Improvement,
Please Specify:
K. Agriculture, Food, Nutrition
Capacity Building
(inc. livestock breeding)
(inc. neighborhood associations,
___________________________
service clubs, bus. development)
CERTIFICATION
I certify that the information furnished in this application and all attached supplementary information is true and correct to the best of
my knowledge, information and belief. I understand the giving of false or incorrect information may constitute a misdemeanor carrying
a penalty upon conviction, for a first offense of not more than two thousand dollars or imprisonment for not more than one year, or
both. A second, or subsequent offense is a felony and upon conviction must be fined not more than five thousand dollars or imprisoned
not more than five years, or both.
Chief Executive Officer:
Chief Financial Officer:
(Signature)
(Signature)
(Print Name)
(Print Name)
(Date)
(Date)
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