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requested information. Otherwise, enter

All financial information for the current

Line 6. Include the income received

“N/A.”

year must cover the period beginning on

from dividends, interest, payments

the first day of the organization’s

received on securities loans (as defined in

Line 7. If your organization is a

established annual accounting period and

section 512(a)(5)), rents, and royalties.

membership organization, enter the

ending on any day that is within 60 days of

Line 7. Enter the total income from all

requested information. Otherwise, enter

the date of this application.

sources that isn’t reported on lines 1

“N/A.”

through 6. Include, for example, income

If the date of this application is less

Line 8. If your organization should

from special events (such as raffles and

than 60 days after the first day of the

cease operations as a tax-exempt

dances) that isn’t taxable as unrelated

current accounting period, no financial

organization, explain to whom its assets

business income. Attach a statement that

information is required for the current year.

will be distributed.

lists each type of revenue source and the

Financial information is required for the

amount derived from each.

Line 9. Indicate if the organization

3 preceding years regardless of the

distributes, or plans to distribute, any of its

Line 9. Enter the expenses directly

current year requirements.

property or funds (such as a distribution of

related to the income sources reported on

profits) to its shareholders or members.

line 3 of this part.

Note. If no financial information is

required for the current year, the

Line 10. Indicate if the organization

Line 10. Enter the expenses directly

preceding year’s financial information can

performs any services for any other

related to the income sources reported on

end on any day that is within 60 days of

organization or individual for which it is

line 4 of this part.

the date of this application.

paid a fee.

Line 11. Attach a statement showing

Prepare the statements using the

the name of the recipient, a brief

Line 11. Don’t include the normal

method of accounting and the accounting

description of the purposes or conditions

salary of officers or employees.

period the organization uses in keeping its

of payment, and the amount paid.

books and records.

Line 12. Answer “Yes” if the

Line 12. Attach a statement showing

organization either provides insurance

If the organization uses a method other

the total amount paid for each benefit

through a third party or provides the

than the cash receipts and disbursements

category, such as disability, death,

insurance itself.

method, attach a statement explaining the

sickness, hospitalization, unemployment

method used.

Line 13. Examples of public regulatory

compensation, or strike benefits.

bodies are HUD, HHS, Public Utilities

A. Statement of Revenue and

Lines 13–18. Use lines 13 through 18

Commission, Housing Commission, and a

Expenses

to report expenses that aren’t directly

state insurance commission.

related to the expense categories listed on

Line 14. Provide the specified

Line 1. Include amounts received from

lines 9 and 10.

information about leased property whether

the members that represent the annual

For example, salaries attributable to the

it is used for exempt functions or for other

dues and any special assessments or

organization’s exempt purpose activities

purposes.

initiation fees.

should be included with any other

expenses reportable on line 9 rather than

Line 15. Provide the specified

Line 2. Don’t include amounts received

being reported separately on line 14.

information about political expenditures

from the general public or a governmental

whether they were made to support or to

unit for the exercise or performance of the

Salaries reportable on line 14 include,

oppose particular candidates.

organization’s exempt function.

for example, those attributable to special

events, to the solicitation of contributions,

Line 16. This includes any printed

Line 3. Examples of such income

and to the overall management and

material that may be used to publicize the

include the income derived by a social

operation of the organization.

organization’s activities or as an

club from the sale of food or beverage to

informational item to members or potential

its members, the sale of burial lots by a

Line 13. Attach a statement that shows

members.

cemetery association, and fees charged

the name of the person compensated, the

by a social welfare organization or trade

office or position, the average amount of

Part III. Financial Data

association for an educational seminar it

time devoted to business per week,

The Statement of Revenue and Expenses

conducted.

month, etc., and the amount of annual

must be completed for the current year

compensation.

Line 4. Enter the organization’s gross

and each of the 3 years immediately

income from activities that are regularly

Line 14. Enter the total of employees’

before it (or the years the organization has

carried on and not related to the

salaries not reported on line 13.

existed, if less than 4).

organization’s exempt purposes.

Line 15. Enter the total interest

Any applicant that has existed for less

Examples of such income include fees

expense for the year, excluding mortgage

than 1 year must give financial data for the

from the commercial testing of products,

interest treated as occupancy expense on

current year and proposed budgets for the

income from renting office equipment or

line 16.

following 2 years.

other personal property, and income from

Line 16. Enter the amount paid for the

Any applicant that has been in

the sale of advertising in an exempt

use of office space or other facilities; heat,

existence more than 1 year but seeks

organization periodical. See Pub. 598 for

light, power, and other utilities; outside

recognition of exemption for only the

information about unrelated business

janitorial services; mortgage interest; real

current year and future years (rather than

income and activities.

estate taxes; and similar expenses.

from the date of its formation) should give

Line 5. Attach a statement showing the

financial data for the current year and

Line 17. If your organization records

description of each asset, the name of the

proposed budgets for the following 2

depreciation, depletion, and similar

person to whom sold, and the amount

years.

expenses, enter the total.

received. In the case of publicly traded

We may request financial data for more

securities sold through a broker, the name

Line 18. Attach a statement listing the

than 4 years if necessary.

of the purchaser isn’t required.

type and amount of each significant

Instructions for Form 1024

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Instructions For Form 1024 - Application For Recognition Of Exemption Under Section 501(A) Page 4

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