Form Nfp-20 - Indiana Not-For-Profit Organization'S Annual Report

NFP-20

(R1 /9-02)

Name of Organization

Federal Identification Number

Part III - Current Information

1. Have you engaged in any activities as a not for profit organization which have not previously been reported to the Indiana Department of Revenue?

If yes, attach a detailed description of such activities.

2. Have you conducted any unlicensed charity events, e.g. Bingo games, raffles, charity game nights, festivals, etc?

If yes, your organization must apply and be licensed by the Charity Gaming Section of the Indiana Department of Revenue, Compliance Division,

100 N. Senate Ave., Room N-203, Indianapolis, IN 46204-2253, telephone (317) 233-4646.

3. Have any changes not previously reported to Department been made in your governing instrument, articles of incorporation, bylaws, or other

instruments of similar importance? If yes, attach a detailed description of changes.

4. Indicate number of years your organization has been in continuous existence.

5. Attach a schedule listing your current officers, addresses, social security numbers and telephone numbers.

6. Briefly describe the purpose or mission of your organization.

I declare under the penalties of perjury that I have examined this return, including all attachments, and to the best of my knowledge and belief, it is true,

complete, and correct.

Signature of officer or trustee

Title

Date

Important:

Please submit this completed form to:

Indiana Department of Revenue

Not-For-Profit Section

P.O. Box 7147

Indianapolis, Indiana 46207-7147

Telephone: (317) 232-2188

Extensions of Time to File

The Department recognizes the Internal Revenue Service application for automatic extension of time to file, Form 8868. Please forward a copy

of your federal extension, identified with your Not-For-Profit registration number, to the Indiana Not-For-Profit Section by the original due

date to prevent revocation of your exemption. Always indicate your Indiana Taxpayer Identification or Not-for-Profit registration number on your

request for an extension of time to file.

Returns received within thirty (30) days after the last date indicated on the federal extension will be considered timely filed. A copy of the federal

extension must also be attached to the Indiana return. In the event that a federal extension is not needed, a taxpayer may request in writing an Indiana

extension of time to file from the Indiana Department of Revenue, Compliance Division, Not-for-Profit Section, Indiana Government Center North,

Room 203, 100 N. Senate Avenue, Indianapolis, Indiana 46204-2253.

If Form NFP-20 or extension is not timely filed, the taxpayer will be notified, by the Department pursuant to I.C. 6-2.5-5-21(d), to file Form NFP-

20. If within sixty (60) days after receiving such notice the taxpayer does not file Form NFP-20, the taxpayer's not-for-profit exemption from sales tax

will be canceled.

Please mail to: Indiana Department of Revenue, P.O. Box 7147, Indianapolis, Indiana 46207-7147