Fillable Lawful Purpose Expenditures (Minnesota Department of Revenue)

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Lawful Purpose Expenditures (Minnesota Department of Revenue)

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General
Organization Name City License Number
Month/Year Reported: _________________ / __________________
Record of Charitable Contributions and Donations:
Lawful Purpose Expenditures
(Rev. 5/13)
This form is used to document an organizations charitable contributions and donations for the purpose of being classied as 4c(3)(ii) property.
Please read instructions before completing form.
C-DR
Total of All A-Code Expenditures: $
Lawful Purpose Expenditures: List your charitable contributions and donations below. Please read instructions before completing.
A list of qualifying A-code expenditures is located on the back of this form.
Contributions and Donations
Date of Check Check Number Check Made Out To: Description (Purpose) A Code Amount
A-
A-
A-
A-
A-
A-
A-
A-
A-
A-
A-
A-
Sign Here
Chief Executive Ofcer:
Print Sign Date
I declare that this form and all records of charitable contributions and donations contained therein, is correct and complete to
the best of my knowledge and belief.
Please provide this form, along with your application, to the county assessor.
In order for your charitable contributions or
donations to qualify, they must have been
contributed towards one of the following
purposes. ese “purposes” are called A-
code expenditures. You must indentify each
of your organization’s charitable contribu-
tions and donations as one of the following
A-code expenditures in the space provided
on the form. (Qualifying A-codes include:
A1 to A7, A10 to A15, and A19.)
A-Codes
A1
• toandby501(c)(3)organizations
• toandby501(c)(4)festivalorganizations
A2
• relievingtheeectsofpoverty,home-
lessness, or disability
A3
• programforeducation,prevention,or
treatment of problem gambling
A4
• fundingapublicorprivatenonprot
education institution registered with or
accredited by Minnesota or any other
state
A5
• scholarships
A6
• recognitionofmilitaryservice(opento
the public)
• activemilitarypersonnelinneed
A7
• foractivitiesandfacilitiesbeneting
youth under age 21
2013 Form Schedule C-DR Instructions
A10
• contributionstotheUnitedStates,state
of Minnesota, or any of its subdivisions
or agencies or instrumentalities (except a
direct contribution to a law enforcement
or prosecutorial agency)
• afundadministeredandregulatedbya
city or county (for lawful purposes)
A11
• toandbyanonprotorganizationwhich
is a church or a body of communicants
A12
• waterqualitytestingforpublicwaters,
provided that the MPCA has approved
the project
A13
• wildlifemanagementprojectthatbenets
the public-at large, provided that the
DNR has approved the project
• costsrelatedtogroomingandmaintain-
ing snowmobile or all-terrain vehicle
trails that are grant-in-aid trails, or other
trails open to public use, provided that
DNR has approved the project.
• suppliesandmaterialsforsafetytraining
and education programs coordinated by
the DNR
A14
• conductingnutritionalprograms,food
shelves, and congregate dining programs
primarily for persons who are age 62 or
older or disabled
A15
• tocommunityartsorganizationsor
expenditures to fund arts programs in the
community
A19
• recognizinghumanitarianservicedemon-
strated through volunteerism or philan-
thropy
Date of check and check number - Enter the
date the check was issued by the organiza-
tion. For allowed electronic transfers, enter
the date of the transfer. Enter the check
numberorelectronictransferconrmation
number.
Check made out to - Enter the name of the
person, organization, or vendor to whom the
check was made out to. is must match the
payee as written on the check. For electronic
transfers, this must match the payee infor-
mation as shown on the bank statement.
Description (purpose) - For each A-code
expenditure, enter a brief description of the
expenditure, such as honor guard, food-
poverty, uniforms, medical bills, city 10%
fund, etc.
Use of Information
e information on this form is required by
MinnesotaStatutes,section273.13toprop-
erly identify you and determine if you qual-
ifyforaspecialpropertytaxclassication.
YourSocialSecuritynumberisrequired.If
you do not provide the required informa-
tion, your application may be delayed or
denied. Your County Assessor may also ask
foradditionalvericationofqualications.
YourSocialSecuritynumberisconsidered
private data.
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Lawful Purpose Expenditures (Minnesota Department of Revenue)

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Completed 6 August 2020

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