Form 8940
(Rev. June 2011)
Department of the Treasury
Internal Revenue Service
Request for Miscellaneous
Determination
OMB No. 1545-2211
Under Section 507, 509(a), 4940, 4942, 4945, and
6033 of the Internal Revenue Code
Use the instructions to complete this form. A User Fee must be attached to this form, if required. For user fee information or
additional help, visit our website at www.irs.gov/eo or call IRS Exempt Organizations Customer Account Services toll-free at
1-877-829-5500. If the required information and documents are not submitted with payment of the appropriate user fee, the form may
be returned to you.
Part I
Identification of Organization
1a Full Name of Organization
b
Address (number, street and room/suite) If a P.O. Box, see instructions.
c City d State e Zip Code + 4
2 Employer Identification Number 3 Month Tax Year
Ends (MM)
4 Person to Contact if More Information is Needed
5 Contact Telephone Number 6 Fax Number (optional) 7 User Fee Submitted
Part II
Type of Request
8
Please select the item(s) below that best describe your request. Using an attachment, provide a detailed explanation of your request. Be sure
to include the organization's name and EIN on each additional sheet.
a Advance approval of certain set-asides described in section 4942(g)(2)
b
Advance approval of voter registration activities described in section 4945(f)
c
Advance approval of scholarship procedures described in section 4945(g)
d
Exemption from Form 990 filing requirements
e
Advance approval that a potential grant or contribution constitutes an “unusual grant”
f
Change in Type (or initial determination of Type) of a section 509(a)(3) organization
g
Reclassification of foundation status, including a voluntary request from a public charity for private foundation status
h
Termination of private foundation status under section 507(b)(1)(B)—advance ruling request
i
Termination of private foundation status under section 507(b)(1)(B)—60-month period ended
Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and to the best of my knowledge and belief, it
is true, correct, and complete.
Please
Sign
Here
▲
(Signature of Officer, Director, Trustee or other authorized official.)
(Date)
(Type or print name of signer) (Type or print title or authority of signer)
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 37756H
Form 8940 (Rev. 6-2011)
