Form As 2645.1 - Application For Tax Exemption Under Section 1101.01 Of The Internal Revenue Code For A New Puerto Rico Page 3

Form AS 2645.1

Page 3 of 4

Rev. Oct 26 11

Name ___________________________________________

YES NO

10.

Indicate the average annual gross income derived during the 4 taxable years prior to submitting this application.

(Include financial statements). In the case of entities that have not begun to operate at the moment of requesting

the exemption, include a forecasted income statement for your first 4 years of operations.

_______________________________________________________________________________________

11.

Submit the following information concerning the board of directors, which must be composed of at least 3

persons and meet the requirements provided by Section 1110.01(d)(2) of the Code.

Name, address, social security number and titles of the entity's officials. Submit schedule, if necessary.

____________________________________________________________________________________

_____________________________________________________________________________________

12.

Annual compensation, salary or wage assigned to the members of the board of directors, administrative officers,

fiduciaries, etc. Submit schedule, if necessary.

_____________________________________________________________________________________

13.

Is the organization controlled or does it control any other corporation? ...........................................................

If the answer is yes, indicate its name.

_____________________________________________________________________________________

____________________________________________________________________________________

14.

Does the organization respond financially to any other organization? ............................................................

If the answer is yes, explain and indicate the other organization's name. Include copy of the reports

submitted to the other organization.

_____________________________________________________________________________________

15.

Is the organization rendering services to other organization and collecting any fees in exchange, or

viceversa?..........................................................................................................................................................

If the answer is yes, explain:

____________________________________________________________________________________

16.

Detail the organization's assets used in its nonprofit operations. If you own other assets used in operations not

subject to the provisions of Section 1101.01 of the Code, submit detail and explain how they are used.

_______________________________________________________________________________________

17.

Indicate the disposition of the assets in case of dissolution of the organization.

_______________________________________________________________________________________

18.

Are any of the organization's property or its operations managed or will be managed by other organization or

person under a lease agreement? ...................................................................................................................

If the answer is yes, explain the relation between the parties and submit copy of the contract.

_______________________________________________________________________________________

19.

Indicate if the operations carried out by the organization were carried out by a for-profit corporation or by an

individual ................................................................................................................................................

If your answer is yes, indicate the legal and commercial name under which they operated.

___________________________________________________________________________________________

20.

Is your organization a membership institution? ..................................................................................................

If your answer is yes:

Describe the membership requirements, cost of annual fee, how fees are determined and which are the

rights and obligations of the members.

_____________________________________________________________________________________

Indicate the benefits received by the members in exchange for fees paid.

_____________________________________________________________________________________

Retention: Fifty (50) years.