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Form Rp-420-A-Org - Application For Real Property Tax Exemption For Nonprofit Organizations - Mandatory Class I-Organization Purpose - 2008 Page 3

RP-420-a-Org (9/08)

a. Date incorporated ____________________ b. State/County in which incorporated

c. Under which law? Law: ________________________ Article or section:

ATTACH COPY OF CURRENT ARTICLES OF INCORPORATION (Note: If a dissolution provision is

not included in the articles, also attach a statement describing how assets would be distributed should the

organization dissolve.)

d. Form of organization

e. Date formed

Has the organization applied for incorporation?

Yes

No - If no, skip to question 6. If yes:

(1) State/County in which application has been filed

(2) Under which Law? Law: ___________________________ Article or section:

(3) Date application filed: _________________________________

ATTACH COPY OF APPLICATION AND CONSENTS REQUIRED WITH APPLICATION

ATTACH COPY OF CURRENT ARTICLES OF ORGANIZATION (Note: If a dissolution

provision is not included in the articles, also attach a statement describing how assets would be distributed

should the organization dissolve.)

6. Is the organization under the supervision of any public regulatory body?

Yes

If yes, answer a through c.

a. Which one(s)? Give name and address

b. Does the organization have an operating certificate, permit, charter, or similar authorization issued

by a public regulatory body?

Yes

IF YES, ATTACH COPY OF AUTHORIZATION

c. Does the organization solicit contributions from the public?

Yes

If yes and the organization is registered with the Attorney General’s Charities Bureau, give the

organization’s registration number

VERIFICATION

State of New York

ss:

County of

______________________, being duly sworn, says that __he is the

the applicant organization, that the statements contained in this application (including the attached

sheets consisting of ____ pages) are true, correct and complete, and that __he makes this application

for real property tax exemption as provided by law.

Subscribed and sworn to before me

this _____ day of ________________, 20__

Signature of owner or authorized representative

Commissioner of deeds or notary public

Form Rp-420-A-Org - Application For Real Property Tax Exemption For Nonprofit Organizations - Mandatory Class I-Organization Purpose - 2008 Page 3