Form 8940 - Request For Miscellaneous Determination

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8940
Request for Miscellaneous
Form
Determination
OMB No. 1545-2211
(Rev. June 2011)
Under Section 507, 509(a), 4940, 4942, 4945, and
Department of the Treasury
6033 of the Internal Revenue Code
Internal Revenue Service
Use the instructions to complete this form. A User Fee must be attached to this form, if required. For user fee information or
additional help, visit our website at or call IRS Exempt Organizations Customer Account Services toll-free at
1-877-829-5500. If the required information and documents are not submitted with payment of the appropriate user fee, the form may
be returned to you.
Part I
Identification of Organization
1a
Full Name of Organization
b Address (number, street and room/suite) If a P.O. Box, see instructions. c City
d State
e Zip Code + 4
2
3 Month Tax Year
4 Person to Contact if More Information is Needed
Employer Identification Number
Ends (MM)
5
Contact Telephone Number
6 Fax Number (optional)
7 User Fee Submitted
Part II
Type of Request
8
Please select the item(s) below that best describe your request. Using an attachment, provide a detailed explanation of your request. Be sure
to include the organization's name and EIN on each additional sheet.
a
Advance approval of certain set-asides described in section 4942(g)(2)
b
Advance approval of voter registration activities described in section 4945(f)
c
Advance approval of scholarship procedures described in section 4945(g)
d
Exemption from Form 990 filing requirements
e
Advance approval that a potential grant or contribution constitutes an “unusual grant”
f
Change in Type (or initial determination of Type) of a section 509(a)(3) organization
g
Reclassification of foundation status, including a voluntary request from a public charity for private foundation status
h
Termination of private foundation status under section 507(b)(1)(B)—advance ruling request
i
Termination of private foundation status under section 507(b)(1)(B)—60-month period ended
Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and to the best of my knowledge and belief, it
is true, correct, and complete.
Please
Sign
(Signature of Officer, Director, Trustee or other authorized official.)
(Date)
Here
(Type or print name of signer)
(Type or print title or authority of signer)
8940
For Paperwork Reduction Act Notice, see separate instructions.
Form
(Rev. 6-2011)
Cat. No. 37756H

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