PART I: Identification of Applicant
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.
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).
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.