Catalog Number 50614A
13909 (Rev. 12-2016)
Form 13909
(December 2016)
Department of the Treasury - Internal Revenue Service
Tax-Exempt Organization Complaint (Referral)
1. Name of referred organization
Street address
City State ZIP code Date of referral
2. Organization’s Employer Identification Number (EIN)
3. Nature of violation
Directors/Officers/Persons are using income/assets for personal gain
Organization is engaged in commercial, for-profit business activities
Income/Assets are being used to support illegal or terrorist activities
Organization is involved in a political campaign
Organization is engaged in excessive lobbying activities
Organization refused to disclose or provide a copy of Form 990
Organization failed to report employment, income or excise tax liability properly
Organization failed to file required federal tax returns and forms
Organization engaged in deceptive or improper fundraising practices
Other (describe)
4. Details of violation
Name(s) of person(s) involved
Organizational title(s)
Dollar amount(s) (if known)
Description of activities
5. Submitter information
Occupation or business
Street address
City State ZIP code Telephone number
I am concerned that I might face retaliation or retribution if my identity is disclosed
6. Submission and documentation: The completed form, along with any supporting documentation, may be mailed to IRS EO
Classification, Mail Code 4910DAL, 1100 Commerce Street Dallas, TX 75242-1198, faxed to 214-413-5415 or emailed to Disclaimer Notice: Your email submission of Form 13909 and attachments are not encrypted for security.
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Catalog Number 50614A
13909 (Rev. 12-2016)
Instructions for Form 13909, Tax-Exempt Organization Complaint (Referral)
General Information
The information provided on this form will help the Internal Revenue Service (IRS) determine if there has been a violation of federal tax
law. Submission of this form is voluntary.
Upon receipt of this form, the IRS will send you a letter acknowledging receipt of the information you submitted. If at a later date you
wish to submit additional information regarding the organization, please attach a copy of the form initially submitted, and send it to the
address shown above.
Specific Instructions
1. Organization name and address: Provide the current name and address of the organization. If the organization has used prior or
multiple name(s) or address(es), also provide that information.
2. Employer identification number: Provide the organization’s EIN.
The EIN is a nine-digit number, issued by the IRS, that the organization uses for tax purposes (like a Social Security Number (SSN)
for an individual). If the EIN is unavailable, include a state nonprofit corporation registration number, if available.
3. Nature of violation: Mark the description that describes the organization’s alleged violation. More than one line may apply. If none of
the descriptions appear to apply, briefly state the issue on the Other line.
4. Details of the violation: Provide specific details of the alleged violation including names, actions, places, amounts, dates, and the
nature of any evidence or documentation (who, what, where, when, how). Include the names of other organizations, entities or
persons that may be involved with the organization, providing EINs or SSNs, if available.
5. Submitter information: Provide your name, address, and business or occupation. Include your daytime telephone number, in case
we wish to contact you. The acknowledgement letter will be sent to the address you provide.
If you are concerned that you may face retribution if your identity is disclosed, check the box. You may enter “Anonymous” for
Submitter’s name if you do not want to be identified.
6. Submission and documentation: Mail the completed form, including any supporting documentation that you would like for us to
review, to the address provided on the form. You may also fax or email the completed form and any supporting documentation to the
fax number or email address provided on the form. Include a cover letter describing the documentation or evidence you are
providing. If you have already received an acknowledgment letter, include a copy of that letter. If possible, please try to submit all
documentation at the same time.
If your referral relates to a church please be aware that Congress has imposed special limitations, found in IRC section 7611, on how
and when the IRS may conduct civil tax inquiries and examinations of churches. You can find out more about these special
limitations in Publication 1828
, Tax Guide for Churches and Religious Organizations, in the section on Special Rules Limiting IRS
Authority to Audit a Church.
7. Claim for reward: To claim a reward for providing this information to the IRS, file Form 211
, Application for Award for Original
8. Note: Federal law prohibits the IRS from providing you with status updates or information about specific actions taken in response to
the information you submit.
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