1023-EZ Form Helper

Step 1 of 6

PART I: Identification of Applicant

1a) Full Name of Organization *

Enter your complete name exactly as it appears in your organizing document, including amendments.

b) Care of Name (if applicable)

c) Mailing Address (number, street, and room/suite). If a P.O. box, see instructions. *

Address Line 1

Address Line 2

City

State

Zip Code

Enter your complete address where all correspondence will be sent. If mail is not delivered to the street address and you have a P.O. box, enter your box number instead of the street address.

2) Employer Identification Number *

Enter the nine-digit EIN assigned to you.

3) Month Tax Year Ends (MM). *

Enter the month that your tax year (annual accounting period) ends, using a two-digit number format. For example, if your annual accounting period ends in December, enter “12.” Your annual accounting period is the 12-month period on which your annual financial records are based. Your first tax year could be less than 12 months. Check your bylaws or other rules of operation for consistency with the annual accounting period entered on line 3.

4) Person to Contact if More Information is Needed *

First

Last

Enter the name and title of the person to contact if more information is needed. The person to contact may be an officer, director, trustee, or other individual who is permitted to speak with us according to your bylaws or other rules of operation. Your person to contact may also be an “authorized representative,” such as an attorney, certified public accountant (CPA), or enrolled agent (EA).

5) Contact Telephone Number *

6) Fax Number (optional)

7) User Fee Submitted *

Enter the user fee amount paid.

8) List the names, titles, and mailing addresses of your officers, directors, and/or trustees. (If you have more than five, see instructions.)

Enter the full names, titles, and mailing addresses of your officers, directors, and/or trustees. You may use the organization's address for mailing. If you have more than five, list only five in the order below.

President or chief executive officer or chief operating officer.
Treasurer or chief financial officer.
Chairperson of the governing body.
Any officers, directors, and trustees who are substantial contributors (not already listed above).
Any other officers, directors, and trustees who are related to a substantial contributor (not already listed above).
Voting members of the governing body (not already listed above).
Officers (not already listed above).

If an individual serves in more than one office (for example, as both an officer and director), list this individual on only one line and list all offices held.

An officer is a person elected or appointed to manage the organization’s daily operations, such as president, vice president, secretary, treasurer, and, in some cases, board chair. The officers of an organization are determined by reference to its organizing document, bylaws, or resolutions of its governing body, or otherwise designated consistent with state law.

A director or trustee is a member of the organization’s governing body, but only if the member has voting rights.

------ Officer 1 ------

Office 1 Name *

First

Last

Officer 1 Title *

Officer 1 Address *

Address Line 1

Address Line 2

City

State

Zip Code

------ Officer 2 ------

Office 2 Name *

First

Last

Officer 2 Title *

Officer 2 Address *

Address Line 1

Address Line 2

City

State

Zip Code

------ Officer 3 ------

Office 3 Name *

First

Last

Officer 3 Title *

Officer 3 Address *

Address Line 1

Address Line 2

City

State

Zip Code

------ Officer 4 ------

Office 4 Name

First

Last

Officer 4 Title

Officer 4 Address

Address Line 1

Address Line 2

City

State

Zip Code

------ Officer 5 ------

Office 5 Name

First

Last

Officer 5 Title

Officer 5 Address

Address Line 1

Address Line 2

City

State

Zip Code

9a) Organization's Website (if available):

b) Organization's Email (optional):

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PART II: Organizational Structure

1 Select the box for the type of organization. *

Corporation
Unincorporated association
Trust

Only certain corporations, unincorporated associations, and trusts are eligible for tax-exempt status under section 501(c)(3). Sole proprietorships, partnerships, and loosely affiliated groups of individuals are not eligible. Check the appropriate box to indicate whether you are a corporation, an association, or a trust.

2) Check this box *

Attest that you have the organizing document necessary for the organizational structure indicated above.

See below for your organization type. Corporation. If incorporated under a federal, state, or federally recognized Indian tribal or Alaskan native government statute, you have a “necessary organizing document” if your organizing document shows certification of filing. This means your organizing document shows evidence that on a specific date it was filed with and approved by an appropriate state authority. Unincorporated association. In order to be a “necessary organizing document,” your articles of organization must include your name, your purpose(s), the date the document was adopted, and the signatures of at least two individuals. Bylaws may be considered an organizing document only if they are properly structured to include your name, purpose(s), signatures, and intent to form an organization. Trust. In order for your trust agreement or declaration of trust to be a “necessary organizing document,” it must contain appropriate signature(s) and show the exact date it was formed

3) Date incorporated if a corporation, or formed if other than a corporation (MMDDYYYY): *

See below for your organization type. Corporation. If you are a corporation, you should enter the date that the appropriate authority filed your articles of incorporation or other organizing document. Unincorporated association. If you are an unincorporated association, you should enter the date that your organizing document was adopted by the signatures of at least two individuals. Trust. If your trust was formed by a trust agreement or a declaration of trust and does not provide for distributions to non-charitable interests, enter the date the trust was funded. Generally, a trust must be funded with property, such as money, real estate, or personal property, to be legally created. If your trust document provides for distributions for non-charitable interests, enter the date on which these interests expired. If your trust agreement continues to provide for non-charitable interests, you will not qualify for tax-exempt status.

4) State of Incorporation or other formation: *

Enter the jurisdiction (for instance, the state or the federally recognized tribal government) under the laws of which you were incorporated or otherwise formed. If you are a corporation, this may not be the place in which you are physically located. For example, if you are physically located in New York, but incorporated under Massachusetts law, enter Massachusetts.

5) Section 501(c)(3) requires that your organizing document must limit your purposes to one or more exempt purposes within section 501(c)(3). *

Check this box to attest that your organizing document contains this limitation.

Your organizing document must limit your purposes to those described in section 501(c)(3). Those purposes are: charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals. See discussion of these purposes under Part III, line 3 of these instructions.

6) Section 501(c)(3) requires that your organizing document must not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes. *

Check this box to attest that your organizing document does not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes.

Your organizing document must not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes described in section 501(c)(3). In other words, you are not organized exclusively for one or more exempt purposes if your organizing documents expressly empower you to carry on activities that further purposes outside the scope of section 501(c)(3), such as “to engage in the operation of a social club” or “to engage in a manufacturing business,” regardless of the fact that your organizing document may state that you are created for “charitable purposes within the meaning of section 501(c)(3) of the Code.”

7) Section 501(c)(3) requires that your organizing document must provide that upon dissolution, your remaining assets be used exclusively for section 501(c)(3) exempt purposes. Depending on your entity type and the state in which you are formed, this requirement may be satisfied by operation of state law. *

Check this box to attest that your organizing document contains the dissolution provision required under section 501(c)(3) or that you do not need an express dissolution provision in your organizing document because you rely on the operation of state law in the state in which you are formed for your dissolution provision.

Your organizing document must permanently dedicate your assets for a section 501(c)(3) purpose. This means that if you dissolve your organization in the future, your assets must be distributed for an exempt purpose described in section 501(c)(3), or to the federal government, or to a state or local government, for a public purpose.

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PART IV: Foundation Classification

1) Are you applying for recognition as a church, school, or hospital (described in section 170(b)(1)(A)(i), (ii), or (iii) of the Internal Revenue Code)? If yes, stop. Do not file Form 1023-EZ. See Instructions *

2) If you qualify for public charity status, check the appropriate box (2a - 2c below) and skip to Part V below.

a) Select this box to attest that you normally receive at least one-third of your support from public sources or you normally receive at least 10 percent of your support from public sources and you have other characteristics of a publicly supported organization. Sections 509(a)(1) and 170(b)(1)(A)(vi).
b) Select this box to attest that you normally receive more than one-third of your support from a combination of gifts, grants, contributions, membership fees, and gross receipts (from permitted sources) from activities related to your exempt functions and normally receive not more than one-third of your support from investment income and unrelated business taxable income. Section 509(a)(2).
c) Select this box to attest that you are operated for the benefit of a college or university that is owned or operated by a governmental unit. Sections 509(a)(1) and 170(b)(1)(A)(iv).

3) If you are not described in items 2a - 2c above, you are a private foundation. As a private foundation, you are required by section 508(e) to have specific provisions in your organizing document, unless you rely on the operation of state law in the state in which you were formed to meet these requirements. These specific provisions require that you operate to avoid liability for private foundation excise taxes under sections 4941-4945.

Select this box to attest that your organizing document contains the provisions required by section 508(e) or that your organizing document does not need to include the provisions required by section 508(e) because you rely on the operation of state law in your particular state to meet the requirements of section 508(e). (See the instructions for explanation of the section 508(e) requirements.)

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1023-EZ Form Helper

PART I: Identification of Applicant

PART II: Organizational Structure

PART III: Your Specific Activities

PART IV: Foundation Classification

PART V: Reinstatement After Automatic Revocation