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Get CA FTB 3500A 2020-2021

Submission of Exemption Request CALIFORNIA FORM 3500A Exemption Based on Internal Revenue Code IRC Sections 501 c 3 501 c 4 501 c 5 501 c 6 501 c 7 or 501 c 19 Federal Determination Letter Enclose a copy of the Federal Determination Letter. 6 m Yes m No Mail form FTB 3500A and a copy of the federal determination letter to EXEMPT ORGANIZATIONS UNIT MS F120 FRANCHISE TAX BOARD PO BOX 1286 RANCHO CORDOVA CA 95741-1286. Under penalties of perjury I declare I have examined this submission for exemption based on the IRC Sections 501 c 3 501 c 4 501 c 5 DATE SIGNATURE OF OFFICER OR REPRESENTATIVE TITLE 8091183 FTB 3500A 2018 Side 1 Part III Purpose and Activity Check the organization s primary purpose and activity m Charitable m Testing for public safety m Hospital m Educational m Religious m Health care center m Literary m Scientific m Prevent cruelty to animals m Church m Qualified sports organization m School m Civic league m Local association of m Social welfare employees m Legislative activities m Service clubs m Veterans organization m Festival organizations m Municipal building m Police sheriff corporation volunteer firemen association m Quasi governmental m Agriculture m AFL-CIO m Horticulture m Independent m Labor m Transportation m Teamsters m Public employees union workers m Board of trade m Business league m Chamber of commerce m Real estate board m Professional association or society m Social and recreational m Car motorcycle m Golf club m Hunting or m Camps m Common recreational trailer club fishing club area m Fraternity or sorority m Flying or airplane club m Dog or horse club. Organization Information California corporation number/California Secretary of State file number FEIN Name of organization as shown in the organization s creating document Web address - Street address suite room or PMB no. State City Telephone Second telephone ZIP code Fax Representative Information Name of representative Email address Part I Entity Information* See instructions. 1 Has the Franchise Tax Board FTB previously revoked the entity s tax-exempt status. 1 m Yes m No If Yes STOP. File form FTB 3500. 2 Is the entity a trust. 2 m Yes m No mm / dd / yyyy 3 When did the organization establish incorporate organize or conduct business in California. 3 4 Provide gross receipts for the current year and the three immediately preceding taxable years in existence. Gross receipts are defined as the total amounts the organization received from all sources during its annual account period without subtracting any costs or expenses. If the organization has been in existence for less than one year provide the projected amount of gross receipts for the entire year. List the account period beginning to the account period ending. Example mm/dd/yyyy Current Year or Projected Gross Receipts From To Part II Group Exemption* See instructions. 5 Is the parent organization applying for a group exemption. 5 m Yes m No If Yes attach the federal group determination letter and a list of all California subordinates..

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