Form 1023 Checklist (Revised June 2006) ‘Application for Recognition of Exemption under Section 01(o)(3) of the Internal Revenue Code Note. Aetna copy ofthe camplated Form 1023 n you permanent record, ler to the General Instuctons| regarding Puole inapecion of approved application. ‘Check each box to fnish your application (Form 1029). Send thie completed Checklist with your filed-in ‘pplication. I you have nat answered al the lems below, Your spotostion may be retumed fo you [Reomplete Z_Assembi the application and mates in his eed: ‘Form 2848, Power of Atomey and Declaration of Representative (fling) 1 Fou 8821, Tax Infermatin Authorization fing) 1 Expect request ff requesting) « Application (Form 1020 and Schedules A through H, as required) «Arcos of organization + Amendments to articles of exganlzation in chronlagical order * Bylaws or otber rules of operation and amencmanis ‘= Documentation of rondiscriminatrypobey for schools, as rqulred by Schedule B «Form 5768, lecton/Revocation of Election by an Eligible Section 601() Organization To Make Expenditures To Infvence Legation ng) 1© i cher attachments, including explanations, franca! data, and printed materia or pubiotions, Label tach page wth mame and EI User feo payment placed in envsope ontop of checks. D0 NOT STAPLE or otherite attach your chock or ‘money order to your apsoaton. Instead, jst pave it inte envelope. Empoyerldenttieation Number) ‘Completed Pars | trough XI of the application, Inudng any requested information and any quired Schosies A trough H * You must prove speciic deals about your past, prosent and planned active. # Generations oF fale to answer questions Inthe Focm 1028 appcation wil prevent us fem recogizing your as tax oxempt ' Descrive your purposes and proposed actite in specie ely undertaod tems. ‘© Frnancil information should comespond win proposed acti. WD sehecis. Submit oly those schedules that apply to you and check ear “Yes" or “No" below. ‘Schedule A Yeo No Schedule Yor Not Schedle B Yes NoY ‘Schodul F Yep No¥ Schedule © Yes Not. Schedue Yor No Schedule D Yea No ‘Schedule Yee NoD_anexact copy of your complete articles of organization (creating document. Absence of the proper purpose ‘and dissolution causes the number one reason for delays nthe Ssuance of deteinalon ites. * Location of Purpose Cause from Par Il ie 1 Page, Atle and Paragraph Numba) PBA Art Pare 12 * Location of Dissolution Clause tom Part Il Ine 20 or 2c Page, tice and Pararaoh Number or by ‘operation of sate aw Pa AM 7.Para 1 Signature ofan office, crctor, trustee, or other oficial who is authorized to sin the application, © Signatur at Pat XI of Form 1028. {2 Your same onthe application rust the same as you legal name a appears in your ates ot ‘ranean Sond completed Frm 1029, wer fee payment, anal other red norman {rtmal Revenue Sevice B.0. Box 192 (Covington, Ky 4012-0102 |W you are using exprees mal ora dlvary service, send Fox 1023, user foe payment and altachmnts to: Internat Revenue Service 201 West Avarcenter Bld ‘Ate Bxractng Stop 312 Covington, KY 101? © romtermntoneswe 2848 Power of Attorney ao and Declaration of Representative Paced bx aearesanee Renae = aaa Pale | min rere ena ih ovis => a eee aa eT won Dapirs eae ta mabe aT Eel a Senet eee opesctti cin anne i oe Saray 1728 Set Sue 600 egos Wosnngion be ae ‘Beier a ga, eae Pel Eka Sam GV ‘cn ibe MAFOR Oe Poy wnat ru, ee Tox Barpon Ses ot mere oy Soles Attn i CAR pov oot pte ao EO so be en atari Spas Uses Not Reerded an CAF ro © fats authorasd Utes ofavite Poe ble, Ue wanes oes = pre soe eas Sacoe cas er wanna ‘rsa ie wai prea we a at pre “ptriod rosie se rape eotoatl hor ot sre oct reste oy misty a Serene mene poses Ray, a bi reponse sadond arvana cara ear Cotelonzetin series Claire rats rgrmerenp Cpe re (risa ncepins,An nr aha pp ‘pero cre Bayh encied eet kt ro ‘acini pehernnat snr, Slowest wamhorpnesnane [ten ape dactra tote aa ote aubotna nt eeepc pupae We at pode sso se) (Geaiania erm) cy eat tga ae ato ar epee Crea N29 reser ‘esr oe oan goon eer 0. of Cro 0 Arama ta ra pa oa yest eee Tavayt tt no ens eon 0! Crt. Sse ne enter ests tn ptr Ova ster eta fo rape oy may ry rcs unda he