Fillable Form 3491 - Consumer Cooperative Exemption Application (Page 2 of 2) in pdf

Form 3491 (Rev. 10-2014)

Page

Instructions

Cedar’s exemption period begins October 2012 and ends

November 2015. Cedar does not have to file Forms 1099-PATR

Section references are to the Internal Revenue Code unless

for 2012, 2013, and 2014, but must file for 2015.

otherwise noted.

Example 2. The facts are the same as in Example 1 except

Cedar made the first payment for 2012 in February, before the

Purpose of Form

exemption is approved. The result is the same. Cedar does not

have to file Forms 1099-PATR for 2012, 2013, and 2014, but

A cooperative may use Form 3491 to apply for exemption from

must file for 2015.

filing Form 1099-PATR, Taxable Distributions Received From

Example 3. In September 2012, Elm Cooperative’s application

Cooperatives. Form 1099-PATR is used to report patronage

for exemption from filing Forms 1099-PATR is approved. In

distributions of $10 or more to a recipient during the calendar

October 2012, Elm made the first patronage payments for the

year.

year. For the tax year ending June 30, 2013, less than 70% of

Who Must File

Elm’s gross receipts are from qualifying retail sales. In August

2013, Elm made the first patronage payments for the new fiscal

Any cooperative that is requesting exemption, under section

year.

6044(c), from filing Form 1099-PATR must file Form 3491 and

Elm’s exemption period begins October 2012 and ends

receive a determination from the IRS. To qualify for the

August 2013. Elm does not have to file Forms 1099-PATR for

exemption, 85% of the cooperative’s gross receipts for the

2012 only.

preceding tax year, or 85% of its total gross receipts for the

preceding 3 tax years, must have been from retail sales of

How To Prepare the Form

goods or services that are generally for personal, living, or family

use (qualifying retail sales). See Regulations section 1.6044-4.

Complete all items on the form. An officer authorized to sign for

the cooperative must sign and date the form.

Period of Exemption

P.O. Box. If the Post Office does not deliver mail to the street

The period of exemption begins with the date the first payment

address and the cooperative has a P.O. box, show the box

is made during the calendar year in which exemption is

number instead of the street address.

approved. It ends on the date the first payment is made after the

Where To File

end of the cooperative’s first tax year in which less than 70% of

the gross receipts is from qualifying retail sales.

Send two copies of the form to:

Examples for Calendar Year Cooperatives

Philadelphia Submission Processing Center

IRP

Example 1. In September 2012, Oak Cooperative’s application

Philadelphia, PA 19255-0633

for exemption from filing Forms 1099-PATR is approved. In

October 2012, Oak made the first patronage payments for the

The IRS will return this application to you showing whether

year. For the tax year ending December 31, 2014, less than

the application has or has not been approved.

70% of Oak’s gross receipts are from qualifying retail sales. In

November 2015, Oak made the first patronage payments for the

year.

Paperwork Reduction Act Notice

Oak’s exemption period begins October 2012 and ends

We ask for the information on this form to carry out the Internal

November 2015. Oak does not have to file Forms 1099-PATR

Revenue laws of the United States. If you want your

for 2012, 2013, and 2014, but must file for 2015.

organization to be considered exempt from filing

Example 2. The facts are the same as in Example 1 except

Form 1099-PATR, you are required to give us this information.

Oak made the first payment for 2012 in February, before the

We need it to determine whether the organization meets the

exemption is approved. The result is the same. Oak does not

requirements of section 6044(c) for exemption status.

have to file Forms 1099-PATR for 2012, 2013, and 2014, but

You are not required to provide the information requested on

must file for 2015.

a form that is subject to the Paperwork Reduction Act unless

Example 3. In September 2012, Maple Cooperative’s

the form displays a valid OMB control number. Books or

application for exemption from filing Forms 1099-PATR is

records relating to a form or its instructions must be retained as

approved. In October 2012, Maple made the first patronage

long as their contents may become material in the

payments for the year. For the year ending December 31, 2012,

administration of any Internal Revenue law. Generally, tax

less than 70% of Maple’s gross receipts are from qualifying

returns and return information are confidential, as required by

retail sales. In March 2013, Maple made the first patronage

section 6103.

payments for the year.

The time needed to complete and file this form will vary

Maple’s exemption period begins October 2012 and ends

depending on individual circumstances. The estimated average

March 2013. Maple does not have to file Forms 1099-PATR for

time for preparing the form is 44 minutes.

2012 only.

If you have comments concerning the accuracy of these time

Examples for Fiscal Year Cooperatives

estimates or suggestions for making this form simpler, we would

be happy to hear from you. You can send us comments from

(July 1–June 30)

Or you can send your comments to

Example 1. In September 2012, Cedar Cooperative’s

Internal Revenue Service, Tax Forms and Publications Division,

application for exemption from filing Forms 1099-PATR is

1111 Constitution Ave. NW, IR-6526, Washington, DC 20224.

approved. In October 2012, Cedar made the first patronage

Do not send the tax form to this address. Instead, see Where To

File, earlier.

payments for the year. For the tax year ending June 30, 2015,

less than 70% of Cedar’s gross receipts are from qualifying

retail sales. In November 2015, Cedar made the first patronage

payments for the new fiscal year.

Form 3491 - Consumer Cooperative Exemption Application Page 2

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