Charities Form 001a - Trusts And Estates Registration Form Char001 - 2000 Page 2

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Charities Form 001a
Page 2 of 2
Daytime Phone______________________________________________
* Attach copy of will, codicils and decree admitting will to probate. Attach copy of federal form
706 and NYS ET-90. COMPLETE PART II.
PART II: COMPLETE ALL ITEMS OF THIS PART
A) Describe and list book value of assets and liabilities (at date of death) below or on
an attached sheet.
B) List name(s) and address(es) of bank depositories and account numbers below or
on an attached sheet.
C) Has an application been made to the Internal Revenue Service for tax exempt status?
______Yes ______No
If yes, has determination letter been issued?
______Yes ______No
*Attached copy of IRS determination letter if issued.
D) List names, addresses and titles of all trustees, executors or administrators
(whichever is applicable).
Name
Address
Title
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
FORM PREPARED BY:
______________________
______________________
______________________
(Signature)
(Name Printed)
(Title)
Address _____________________________________________________________________
Phone Number __________________________________ Date _________________________
3/3/00

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