Form 8940 Form 8940 Request for Miscellaneous Determination

8940

Form
(Rev. June 2011)

Department of the Treasury
Internal Revenue Service

Request for Miscellaneous
Determination

Under Section 507, 509(a), 4940, 4942, 4945, and
6033 of the Internal Revenue Code

OMB No. 1545-2211

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
1a

Identification of Organization
Full Name of Organization

b Address (number, street and room/suite) If a P.O. Box, see instructions. c City

2

Employer Identification Number

5

Contact Telephone Number

Part II
8

3 Month Tax Year
Ends (MM)

d State

e Zip Code + 4

4 Person to Contact if More Information is Needed

6 Fax Number (optional)

7 User Fee Submitted

Type of Request

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.)

(Type or print name of signer)

For Paperwork Reduction Act Notice, see separate instructions.

(Date)

(Type or print title or authority of signer)
Cat. No. 37756H

Form 8940 (Rev. 6-2011)