Form 3500a Draft - Affirmation Of Internal Revenue Code Section 501(C)(3) Page 3

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Location of Dissolution Clause (page, article, and paragraph number) _____________________________________________________________
Articles of Association
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m
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Religious Purpose
Charitable Purpose
Public Purpose
m
Location of Charitable Purpose (page, article, and paragraph number) _____________________________________________________________
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Location of Political Limitation Clause (page, article, and paragraph number) _______________________________________________________
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Location of Dedication Clause (page, article, and paragraph number) ______________________________________________________________
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Location of Dissolution Clause (page, article, and paragraph number) _____________________________________________________________
Articles of Organization
m
m
m
Religious Purpose
Charitable Purpose
Public Purpose
m
Location of Charitable Purpose (page, article, and paragraph number) _____________________________________________________________
m
Location of Political Limitation Clause (page, article, and paragraph number) _______________________________________________________
m
Location of Dedication Clause (page, article, and paragraph number) ______________________________________________________________
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Location of Dissolution Clause (page, article, and paragraph number) _____________________________________________________________
Additional Information
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This organization is currently active
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Corporation is suspended
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Bylaws are available upon request
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Returns have been filed: Years filed _________________________________________________________________________________________
Has the organization filed state tax returns? If so, state type of returns and years filed _____________________________________________________
________________________________________________________________________________________________________________________
Has the organization filed federal tax returns? If so, state type of returns and years filed ___________________________________________________
________________________________________________________________________________________________________________________
Has the organization ever been suspended, revoked or audited by the IRS? If so, explain __________________________________________________
________________________________________________________________________________________________________________________
Group Exemption – All Subordinates are:
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Unincorporated
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Section 501(c)(3) Organizations
Federal Group # _________________________________________
Attach a list of all California Subordinates, include mailing addressed and identification number .
Under penalties of perjury, I declare that I have examined this request for affirmation and to the best of my knowledge and belief, it is true,
correct, and complete.
_________________________
________________________________________________________
______________________________
*
DATE
SIGNATURE OF OFFICER OR REPRESENTATIVE
TITLE
*
Signature of an officer, director, trustee, or other official who is authorized to sign the affirmation.
Side  FTB 3500A
(NEW 2007)
8092073
C1

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