Form 990-PF Return of Private Foundation or Section 4947(a)(1) Nonex

Tax Year 2006 RIS Notification

Form 990-PF, Return of Private Foundation

Attached is a marked up draft that can be used to devebp any necessary RIS(s) for
the 2007 processing year. The major changes are as follows:
We added lines 11 a and 11b to Part VII-A to reflect act section 1205(b) of the Pension Protection Act of
2006 and line 12 to Part VII-A at the request of Treasury and TElGE to assist in implementing act section
1211 of the Pension Protection Act of 2006.

We do not anticipate the need for any further changes that would affect a RIS.

We may need to make further changes that would affect this RIS.
his transmittal can be used to create a Placeblder RIS. We expect to make further changes.

If you have any questions, please contact the tax law specialist shown below, or the
reviewer on line 2 (above).
From:
Carl Medley
Tax Law Specialist
SE:W:CAR:MP:T:T:F~

Initiats:
Date:
September18,2006

Room:

6045

Phone Number:
(202) 283-0387

Email:
carl.medley @ irs.gov

Fax Number:
(202) 283-4759

Return of Private Foundation

)

under section 507@)(t)(A),check here

if the foundation is not required to attach Sch.
3 Interest on savings and temporary cash investments
4 Dividends and interest from securities . . .
5a Gross rents . . . . . . . . . . . .
b Net rental income or (loss)
6a Net gain or (loss) from sale of assets not on line 10
b Gross sales price for all assets on line 6a
7 Capital gain net income (from Part IV, line 2) .
8 Net short-term capital gain . . . . . . .

.b

2 Check b

10a Gross sales less returns and allowances
b Less: Cost of goods sold . .
c Gross profit or (loss) (attach sche
11 Other income (attach schedule) .

.

.
.

. . . . .

s 13 Compensation of officers, directors, trustees, etc.
Q1

14 Other employee salaries and wages . . . . .
15 Pension plans, employee benefits . . . . . .
16a Legal fees (attach schedule) . . . . . . . .
b Accounting fees (attach schedule) . . . . . .
,c Other professional fees (attach schedule). . . .
$U1 17 Interest . . . . . . . . . . . . . . .
.- 18 Taxes (attach schedule) (see page 14 of the instructions)
-z
f 19 Depreciation (attach schedule) and depletion . .
20 Occupancy. . . . . . . . . . . . . .
rr 21 Travel, conferences, and meetings. . . . . .
22 Printing and publications
23 Other expenses (attach schedule) . . . . . .

g

2

2

. . . . . . . . .

= 24

m-

Total operating and administrative expenses.

For Privacy Act and Papemork Reduction Act Notice, see the instructions.

Cat. No. 11289X

~ o r m990-PF

pm)

Page

Form NO-PF (2006)

2

Attached schwles

h investments

. . . . . .

Less: allowance for doubtful accounts b.......................
Pledges receivable b............................................
Less: allowance for doubtful accounts b..............
5 Grants receivable . . . . . . . . . . .

4

instructions)

. . . . . .
. . . .

b Investments-orporate
stock (attach
c Investments-corporate bonds (attach

Less: accumulated depreciation (attach schedule) b...................

. . . . . .
.-$ 19
.- 20
=
.- I
22
@

J

Deferred revenue. . . . . . . . . . . . . . .
Loans from officers, directors, trustees, and other disqualified persons
Mortgages and other notes payable (attach schedule) . .
Other liabilities (describe b .....................................
)

23 Total liabilities (add lines 17 through 22)

. . . . . .

Organizations that follow SFAS 117, check here b
and complete lines 24 through 26 and lines 30 and 31.

E

24 Unrestricted . . . . . . . . . . . . . . .
25 Temporarily restricted . . . . . . . . . . . .
26 Permanently restricted . . . . . . . . . . . .
Organizations that do not follow SFAS 117, check here b
and complete tines 27 through 31.
27

Capital stock, trust principal, orcurrent funds

.

.
.

. . . . .

$ 28 Paid-in or capital surplus, or land, bldg., and equipment fund .
$ 29 Retained earnings, accumulated income, endowment, or other funds .
tn
4 30 Total net assets or fund balances (see page 17 of the
CI

instructions)

. . . . . . . . . . . . . . . .

31 Total liabilitiesand net assets/fund balances (see page 17 of the

Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year-Part II, column (a), line 30 (must agree with
end-of-year figure reported on prior year's return) . . . . . . . . . . . . . . . ,
2 Enter amount from Part I, line 27a. . . . . . . . . . . . . . . . . . . . . .
3 Other increases not included in line 2 (itemize) b ..........................................................
4 Add lines 1 , 2 , and 3 . . . . . . . . . . . . . . . . . . . . . . . . . .
. .
.
.
5 Decreases not induded in line 2 (itemize) F ................................................................

1

2

3
4
5
Form 990- PF (2006)

If gain, also enter in Part I, line 7
If (loss), enter -0-in Part I, line 7

2 Capjtal galn net income or (net capital loss)

3 Net short-term capital gain or (loss) as defined in sections 1222(5)and (6):
If gain, also enter in Part I, line 8, column (c) (see pages I3 and 17 of the instructions).l
If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . . . . . .
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income

(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment jncome.)
If section 4940(d)(2) applies, leave this part blank.
Was the organization liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the organization does not qualify under section 4940(e). Do not complete this part.

Yes

fl No

1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.

(4

Base period years
Calendar year (or tax year beginning in)

Ib)

Adjusted qualifying distributions

(dl

(4

Distribution ratb
(cot (b, divided by ml,(c))

Net value of noncharitable-uw assmts

2005
2004

2003
2002
2001
2 Total of line 1, column (

. . . . . . . . . . . . . . . . . . . . . .

2

3 Average distribution ratio for the 5-year base period4ivide the total on line 2 by 5, or by the
number of years the foundation has been in existence if less than 5 years

. . . . . .

3

. . . . .

4

4 Enter the net value of noncharitable-use assets for 2006 from Part X, line 5 .

5 Multiply line 4 by line 3

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . .

6

. . . . . . . . . . . . . . . . . . . . . . . . .

7

6 Enter 1% of net investment income (I % of Part I, line 27b)

7 Add lines 5 and 6

5

8 Enter qualifyinq
. . . . . . . . . . . . . . 8
.
. - distributions from Part XII, line 4
If line 8 is equal to or greater than line 7, check the box in Part VI, line Ib, and complete that part using a 1% tax rate. See
the Part VI instructions on page 18.
Form

990-PF(2006)

Paoe

Form SW-PF I20061

4

l a Exempt operating foundations described In sectlon 494qd](2), c h e k here b
and enter "N/A on line I .
Date of ruling letter: ............... (attach copy oi ruling letter if
b Domestic organizations that meet the sect~on 4940(e) requirements in Part V,
here b [3 and enter 1% of part I, line27b.
c All other domestic organlzatlons enter 2% ol line 27b. Exempl forelon Drgan~zat~ons
enter 4 % 2 &
2 Tax under section 511 (domestic section 4947(a)(l) trusts and taxable foundati
3 Add lines 1 and 2. . . . . . . . . . . . .
4 Subtitle A (income) tax (domestic sect~on4947(a)(l)tnrsts and 1
5 Tax based on investment income. Subtract line 4 &
6 Credits/Payrnents:
r i
a 2006 estimated tax
b Exempt foreign organizations--tax
c Tax paid with application for
d Backup withholding

. . . . . . . . . .
.1

. . . .

7
8
9
10

11

Total cred~tsand payments. Add lines
through 6
Enter any penalty for underpayment of e s t i m w t'
Tax due. If the total of lines 5 and 8 is rnord
Overpayment. If line 7 is more than the to
Enter the amount of line 10 to ba: Credited to :

1

. . . . . . . .

Form 2220 is attached
owed . . . . . b

l a Dunng the tax year, did the organization attempt to influence any national, state, or local legislation or did it

participate or intervene in any political campaign? . . . . . . . . . . . . . . . . . . .
b Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19
of the instructions for definition)? . . . . . . . . . . . . . . . . . . . . . . . .
I f the answer is "Yes" to la or lb, attach a detailed description of the activities and copies of any materials
published or distributed by the organization in connection with the activities.
c Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . .
d Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(2) On organization managers. b $
(1) On the organization. b $
e Enter the reimbursement (if any) paid by the organization during the year for political expenditure tax imposed
on organization managers. b $
2 Has the organization engaged in any activities that have not previously been reported to the IRS? . .
If "Yes," attach a detailed description of the activities.
3 Has the organization made any changes, not previously reported to the IRS, in its governing instrument, articles of
incorporation, or bylaws, or other similar instruments?If"Yes," attach a conformed copy of the changes . . .
4a Did the organization have unrelated business gross income of $1,000 or more during the year? . . .
b If "Yes," has it filed a tax return on Form 990-T for this year?
. . . . . . . . . . . . . .
Was
there
a
liquidation,
termination,
dissolution,
or
substantial
contraction
during the year?. . . . .
5
If "Yes," attach the sfatement required by General Instruction T.
6 Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or

1

I

1

By state legislation that effectively amends the governing instrument so that no mandatory directions that
conflict with the state law remain in the governing instrument? . . . . . . . . . . . . . .
7 Did the organization have at least $5,000 in assets at any time during the year? I f "Yes," completa Part /I, ml. (c), and Part XV
8a Enter the states to which the foundation reports or with which it is registered (see page 19 of the
instructions) b ...........................................................................................................
b If the answer is 'Yes" to line 7, has the organization furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G? If 'No, " attach explanation . .
9 Is the organization claiming status as a private operating foundation within the meaning of section 4942()(3)
or 4942(i)(5)
for calendar year 2006 or the taxable year beginning in 2006 (see instructionsfor Part XIV on page
26)? If "Yes," complete Part XIV . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Did any persons become substant~ acontributors
l
during the tax year? If 'Yes, 'attach a sdrduie listing their names and addresses
11 Did the organization comply with the public inspection requirements for its annual returns and exemption application?
Web site address b .......................................................................................................................
12 The books are in care of F ...............................
.
.
...
.
.
........................ Telephone no. b ......................
Located at b ...................
...............
............................................
ZIP+4 b .............................
13 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1 0 4 1 4 h e c k here. . . . . . F
and enter the amount of tax-exempt interest received or accrued during the year . . . . b [ 13 1
F

O

99&PF
~

(200s)

1 la At any time during the year, did the foundation, dlrectly or ~nd~rectly,
own a controlled entity w~thinthe meaning of

.I la. Yes - No

section 51 2(b)(l3)? . .
If yes, attach schedule. (See instructions.)

I l b If "Yes." d ~ dihe foundation have a binding written contract in effect on August 17, 2006, covering the interest, rents,
royalties and annuities described
rn the attachment b r line I l a ? . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. I l b Yes-No

.

12 Did Ihe organization acquire a direct or indirect interest in any applicable insurance contract?

12

Yes -No

ape 5

Form 990-PF 12006)

!nts Reg
File Form 4720 if any item is cheeked in the "Yes" column, unless an exception applies.]
la During the year did the organization (either directly or indirectly):
Ill
in the sale or exchanse, or leasina of ~ r o ~ e rwith
t v a disqualified person?.
. . Enaaae
u "
(2) Bon*OW money from, ten
disqlualified pelson?. .
(3) Furnish goods, services, or facilities to (or accept them from) a dis
(4) Pay compensation to, or pay or reimburse the e x p e n w
disc
(5) Transfer any income or assets to a disqualified person
the benefit or use of a disqualified person)? . .

a

-:

(6) Agree to pay money or property to a gov_e~d
the organization agreed to m
termination of government se
b If any answer is "Yes" to 1a(l H6), did
section 53.4941Id)-3 or in a current not:
Organizations relying on a current notickregarding m e ;
c Did the organization engage in a prior year in ~
o
i
were not corrected before the first day of
2 Taxes on failure to distribute income (sectiori
operating foundation defined in section 4942
. . .
a At the end of tax year 2006, did the organization have any undistributed income (lines 6d
and 69,Part Xlll) for tax year(s) beginning before 2006? . . . . . . . . . . . .
If "Yes," list the years b 20 .... , 20 .... , 20 .... , 20 .....

tq

-

Yes

No

b Are there any years listed in 2a for which the organization is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year's undistributed income? (If applying section 4942(a)(2)
to all years listed, answer "No" and attach statement-see page 20 of the instructions.) . . . . . . .
e If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
F 20 .... , 20 .... , 20 .-.-, 20 - - - - -

I

t-

b If "Yes," did it have excess business holdings in 2006 as a result of (1) any purchase by the organization or
disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the
Commissioner under section 4943(c)(7)) to dispose of holdings acqu~redby gift or bequest; or (3) the lapse
of the lo-,15-,or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine if the
organrzation had excess business holdings in 2006.) . . . . . . . . . . . . . . . . . .
4a Did the organization invest during the year any amount in a manner that would jeopardize its charitable purposes?
b Did the organization make any investment in a prior year but after December 31. 1969)that could jeopardize its charitable
purpose that had not been removed horn jeopardy before the first day of the t a year winning in 20061. . . . .
5a During the year did the organization pay or incur any amount to:
(1) Carry on propaganda. or otherwise attempt to influence legislation (section 4945(e))? .
Yes
NO
(2) Influence the outcome of any specific public election (see section 4955); or to carry on,
d~recilyor indirectly. any voter registration drive? . . . . . . . . . . . . .
Yes
No
(3) Provide a grant to an individual for travel, study, or other similar purposes? . . . .
Yes
No
(4) Provide a grant to an organization other than a charitable, etc., organization described in
section509(a)(1),(2),or(3),orsection4940(d){2)7 . . . . . . . . . . . . . n ~ e sU u o
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?.
Yes
No
b If any answer is 'Yes" to 5a(1)-(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 20 of the instructions)?
Organizations relying on a current notice regarding disaster assistance check here. . . . . . b
e If the answer is "Yes" to question 5a(4), does the organization claim exemption from the tax
because it maintained expenditure responsibility for the grant?. . . . . . . . . .
yes
NO
I f "Yes, " attach the statement required by Regulations section 53.49455fd).
6a Did the organization, during the year, receive any funds, directly or indirectly,to pay premiums
Yes
on a personal benefit contract? . . . . . . . . . . . . . . . . . . . .
b Did the organization, during the year. pay premiums, directly or indirectly, on a personal benefit contract?
I f you answered "Yes" to 6b, also file F m 8870.
7a At any time during the tax year, was the organization a party to a prohibied tax shelter transaction?
yes
b If yes, did the organization receive any proceeds or have any net income attributable to the transaction? .

.

I
I

No

. .
No

. .
~ o r m990-PF 120061

Form 990-PF (2036)

Page

6

Information About Officers, Directors, Trustees, Foundation Managers,

and Contractors
1 List all officers, direct
ours per wee

[ devoted to position

la1 Name and address of each employee pad more than $50,000

I

4-)

-

""-'

",pensation

land-

""",'"''"""

,

I

I

I

I

I

Total number of other employees paid over $50,000. . . . . . . . . . . . . . . . . . . . . . w
3 Five highest-paid independent contractors for professional services (see page 2 t of the instructions). If none, enter
'NONE."
(a) Name and address of each person paid more than $50,000

@) Type of service

I

(c) Compensation

I

Total number of others receiving over $50,000for professional services

. . . . .

.

. . . . . . .

. . b

I

Summary of Direct Charitable Activities

Form 990-PF (Zoos)

Page

Form 990-PF (2006)

purposes:

. . .
a Average monthly fair market value of securi
b Average of monthly cash balances . . .
e Fair market value of all other assets (see pa
the instructions) .
d Total (add lines 1a, b, and c) . . . . . . . . . . . . . . .
e Reduction claimed for blockage or other factors reported on lines l a and
Ic (attach detailed explanation) . . . . . . . . . . . . . .
3
4

Subtract line 2 from line Id . . . . . . .
Cash deemed held for charitable activities. Enter
of the instructions) . . . . . . . . . .

7

. . . . . . . . .
. . . . . . . . .
. . . . . . . . .

. . . . . . . . . . . . . . . . .
11/2%

of line 3 (for greater amount, see page 23

. . . . . . . . . . . . . . . . .

. . . . . . . . .
b Income tax for 2006. (This does not include the tax from Part VI.) . .
c Add l~nes2a and 2b . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Distributable amount before adjustments. Subtract line 2c from line 1 . . . . . . . . . .
4 Recoveries of amounts treated as qualifying distributions . . . . . . . . . . . . . .
5 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Deduction from distributable amount (see page 24 of the instruct~ons). . . . . . . . . .
7 Disbibutable amount as adiusted. Subtract line 6 from line 5. Enter here and on Part XIII.
line 1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Qualifying Distributions (see page 24 of the instructions)
Amounts paid (including administrative expenses) to accomplish charitable, etc.,
a Expenses, contributions, gifts, etc.-total from Part I, column (d), line 26 . . . . . . . . .
b Program-related investments-total from Part IX-B . . . . . . . . . . . . . . . .
2 Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Amounts set aside for specific charitable projects that satisfy the:
a Suitability test (prior IRS approval required) . . . . . . . . . . . . . . . . . . .
b Cash distribution test (attach the required schedule) . . . . . . . . . . . . . . . .
4 Qualifying distributions. Add lines la through 3b. Enter here and on Part V, line 8, and Part XIH, tine 4 , ,
5 Organizations that qualify under section 4940(e) for the reduced rate of tax on net investment income.
Enter 1% of Part I, line 27b (see page 24 of the instructions) . . . . . . . . . . . . .
6 Adjustedqualifyingdistributions.Subtractline5from line4 . . . . . . . . . . . .
Note:The amount on line 6 will be used in Part V, column 0,in subsequent years when calculating whether the foundatjo~
qualifies for the section 4940(e) reduction of fax in those years.
Form 990-PF (200s)
1

~orm
990-PF (2006)

Undistributed Income (see page 24 of the instructions)

Page

8

t

Form 990-PF (200s)

Form 990-PF (2006)

Page

9

foundation, and the ruling is effective for 2006, enter the date of the ruling . . . . .
the or
2a Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for
eachyearlisted . . . . . .
b 85% of line 2a . . . . . . .
b Check box to indicate whether

c Qualifying distributions from Part XII,
line 4 lor each year listed

. . .

d Amounts included in line 2c not used directly

for active conduct ot exempt activities

. .

e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c . .
Complete 3a, b, or c for the
alternative test relied upon:
a "Assets" alternative test-enter:
(1) Value of all assets. . . . .
(2) Value of assets qualifying
under section 49420)(3)(B)(i) .
b "Endowment" alternative test--enter Y3 of
minimum ~nvestrnentreturn shown in Part
X, line 6 lor each year listed . . .
c "Support" alternative test--enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments on
securit~esloans (section
512(a)(5)), or royalties) . . .
(2) Support from general public
and 5 or more exempt
organizations as provided in
sect~on4942(j)(3)(B)(iii) . . .
(3) Largest amount of support from
an exempt organization . . .
(4) Gross investment income . .

3

v

f

m

a
t
i
o
n (Complete this part only if the organization had $5,000 or more in
assets at any time during the year--see page 26 of the instructions.)
t Information Regarding Foundation Managers:
a List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000).(See section 507(d)(2).)
of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.

b List any managers of the foundation who own 10% or more of the stock

2

lnformation Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:

Check here b
if the organization only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the organization makes gifts, grants, etc. (see page 26 of the instructions) to individuals or
organizations under other conditions, complete items 2a, b, c, and d.
a The name, address, and telephone number of the person to whom applications should be addressed:

b The

form in which applications should be submitted and information and materials they should include:

c Any submission

deadlines:

d Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other

factors:

I

Total

I

I

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b

3a

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b

3bl

b Approved for future payment

I

Total

I

I

I

Form 990-PF (2006)

Paw

Form 990-PF (20C6)

11

1 Program service revenue:

Debt-financed property . . . . . .
b Not debt-financed property . . . . .
Net rental income or (loss) from personal prope,.
Other investment income . . . . . . . .
Gain or (loss)from sales ol assets other than inventory
Net income or (loss) from special events. . .
Gross profit or (loss) from sales of inventory .
Other revenue: a

a
6
7
8
9
10
11

e
12 Subtotal. Add columns (b), (d), and (e) . . .
13 Total. Add line 12, columns (b).
. .-Id),
. . and (el . . . . . . . .
(See worksheet in line 13 instructions on page 27 to verify calculations.)

. . . . . . . . .

13

Relationship of Activities to the Accomplishment of Exempt Purposes
Explain below how each activity for which income is reported in column (e) of Part XVl-A contributed importantly to
the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes). (See
page 27 of the instructions.)

Line No'

v

I

Form

WO-PF (ZOOS)

Form 990-PF (2006)

(1) Cash.

Page

12

. . . . . . . . . . . . . . . . . . . .
. . . . .

(2) Other assets . . . . . . . . . . . . .
b Other transactions:
(1) Sales of assets to a noncharitable exempt organizati

. . . .

. . . .

(4) Reimbursement arrangements
(5) Loans or loan guarantees. .
(6) Performance of services or me
c Sharing of facilities, equipment, mail

. . . . . .

. . . . . . .

ransfers, transactbms. and sharing arrangements

2a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? . . . . . . .
b If 'Yes,"complete the following schedule.
(a) Name of organization

1

(c) Description of mlationship

I

?
m

No

Under penalties of perjury, I declare that I haw exam~nedth~sreturn, including accom nying schdules and staternem, and to the best of my knowledge and
belief, it is true, c o r n and complsts Dglnratlan oreparer ( 0 t h than taxpayer or &cia*
is bared on all information of which preparer har any h o w l a g e .

Signature of oficer or bustee

C

I

(b) Type of organization

Yes

Date

Date
Check d
self-employed b

m

~2

t? Q $6
a
23

Preparer's
signature

L=

F~rm'sname (or address.
self-amplayid),
yours if
and ZIP code

,
I

Preparer's SSN or PTlN
(See Signature on page 28
of the instructions.)

1

EIN b
Phone no. (

1

Form

W P F (2006)