Form 13909 - Tax-Exempt Organization Complaint (Referral)
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1
2Department of the Treasury - Internal Revenue Service
13909
Form
Tax-Exempt Organization Complaint (Referral)
(December 2016)
1. Name of referred organization
Street address
City
State
ZIP code
Date of referral
2. Organization’s Employer Identification Number (EIN)
3. Nature of violation
Directors/Officers/Persons are using income/assets for personal gain
Organization is engaged in commercial, for-profit business activities
Income/Assets are being used to support illegal or terrorist activities
Organization is involved in a political campaign
Organization is engaged in excessive lobbying activities
Organization refused to disclose or provide a copy of Form 990
Organization failed to report employment, income or excise tax liability properly
Organization failed to file required federal tax returns and forms
Organization engaged in deceptive or improper fundraising practices
Other (describe)
4. Details of violation
Name(s) of person(s) involved
Organizational title(s)
Date(s)
Dollar amount(s) (if known)
Description of activities
5. Submitter information
Name
Occupation or business
Street address
City
State
ZIP code
Telephone number
I am concerned that I might face retaliation or retribution if my identity is disclosed
6. Submission and documentation: The completed form, along with any supporting documentation, may be mailed to IRS EO
Classification, Mail Code 4910DAL, 1100 Commerce Street Dallas, TX 75242-1198, faxed to 214-413-5415 or emailed to
eoclass@irs.gov. Disclaimer Notice: Your email submission of Form 13909 and attachments are not encrypted for security.
13909
Catalog Number 50614A
Form
(Rev. 12-2016)
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