Request 990N Assistance

Principal Officer Name *

First

Last

Principal Officer Address *

Address Line 1

Address Line 2

City

State

Zip Code

Principal Officer Phone Number *

Organization Legal Name *

Organization d/b/a

Organization Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Website Address

Organization Phone Number *

Employer Identification Number (EIN) *

Tax Year *

Do you confirmation that the organization’s annual gross receipts are $50,000 or less?

Yes, I confirm.
No, the organization's annual gross receipts were MORE than $50,000 for this tax year.

Has the organization terminated?

Yes, the organization has terminated.
No, the organization has not terminated

Is the organization planning to terminate (go out of business)?

Yes, the organization is planning to terminate.
No, the organization is not planning to terminate.

I authorization Michael Hearn, (IRS Tax Preparer #P02165481) and Affiliate of Dewlyn Capital Partners to Prepare and Submit my IRS 990N for the tax year indicated herein. *

Name *

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Last

I am a member of Community Heroes: *

Request for 990N Assistance

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