Form Vfirs - Verification Of Filing With The Internal Revenue Service Form June 2009

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VERIFICATION OF FILING WITH THE INTERNAL REVENUE SERVICE
This form is to be completed by 501(c)(3) non-profit organizations, located in Ohio, that file one
of the federal tax forms listed below. NOTE: This form should be filed in lieu of a copy of the
federal tax return. Do not submit the federal return with this form.
I hereby certify that I am a trustee or officer of
_______________________________________________________________________________________
(Name of Organization as filed with the Attorney General’s Office)
_______________________________________________________________________________________
Charity Street Address
City
Zip Code
_____________________________________
____________________________________
(Federal Employer Identification Number)
(State Charter Number if applicable)
and that the above named organization completed and/or will complete and file: (check one)
Form 990
Form 990-PF
Form 990-EZ
Form 990-N (e-Postcard)
required by the Internal Revenue Service for the: (check and complete one of the following)
calendar year 2 _ _ _
tax year beginning ____________, 2 _ _ _ , and ending ______________, 2 _ _ _
and that such filing occurred on/or will occur on
_______________________________.
(Filing Date)
Did the organization request a federal extension of time to file this report?
Y
N
If yes, what was/is the extended due date
? ____________________________________________
(Federal Extended Due Date)
For fee purposes, please indicate the current total value of assets, or if filing this form prior to an extended
federal due date, estimate the current total value of assets, at year end $
_________________________
_____________________________________
________________________________
Name of Trustee/Officer (Please Print)
Telephone number
________________________________________
___________________________________
Signature of Trustee/Officer
Charitable Organization E-mail Address
________________________________________
OFFICE USE ONLY
Trustee/Officer Title
FILING FEE PAID
Amount _____________
________________________________________
Date ________________
Date
Check #______________
VFIRS/Revised 6/09
Charitable Law Section
150 East Gay St 23rd Fl ● Columbus, Ohio 43215 ● PHONE 614.466-3181 ● FAX 614.466-9788 ●

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