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Name IRS USE ONLY Address 990-C 990-PF CT-1 City State Telephone number 1st Quarter 990-T TAX PERIOD MONTH TAX YEAR ENDS Signature 2nd 3rd 4th ZIP FOR BANK USE IN MICR ENCODING Federal Tax Deposit Coupon Form 8109-B Rev. 12-2005 SEPARATE ALONG THIS LINE AND SUBMIT TO DEPOSITARY WITH PAYMENT Note. Do not staple tape or fold the coupons. Fo The IRS encourages you to make federal tax deposits using the Electronic Federal Tax Payment System EFTPS. Fo.

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