Form As 2645.1 - Application For Tax Exemption Under Section 1101.01 Of The Internal Revenue Code For A New Puerto Rico Page 2

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Form AS 2645.1
Page 2 of 4
Rev. Oct 26 11
Name ___________________________________________
Part II - Information Concerning Activities and Operations
YES
NO
1.
Describe in detail your past and current activities as well as the activities planned for the future (Do not quote
from the Articles of Incorporation). Describe each activity separately in order of importance. Indicate its
purpose, when it began or will begin, who and where it will be realized. Submit shedule, if necessary.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
2.
Indicate the organization's source or sources of income.
______________________________________________________________________________________
______________________________________________________________________________________
3.
Describe the programs of activities to collect funds, if any, and the way they will be done.
______________________________________________________________________________________
______________________________________________________________________________________
4.
Indicate how income and surplus, if any, are used.
______________________________________________________________________________________
______________________________________________________________________________________
5.
Does the organization provide any kind of insurance plan to its members, employees, partners or executives,
their dependents or other persons (include payments of benefits from sickness or death, pensions or annuities)?
If the answer is yes, explain the eligibility requirements and include as an example, a copy of each insurance
plan issued and of each plan.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Is the organization under the supervision of any governmental agency such as the Department of Family Affairs
6.
or the Department of Health? .........................................................................................................................
If the answer is yes, include copy of all administrative opinions, judicial determinations, etc.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
7.
Does the organization spend or plan to spend money to influence judicial determinations subject to legislation
in its favor, or in favor of some of its employees, any member of its Board of Directors, etc.? ......................
If the answer is yes, explain how the recipients or beneficiaries are, or will be benefited.
______________________________________________________________________________________
______________________________________________________________________________________
8.
Has the organization issued any booklets, letters, magazines, informative bulletins or any similar material? ...
If the answer is yes, include copies.
______________________________________________________________________________________
______________________________________________________________________________________
9.
What percent (%) of the net income is distributed to the benefit of any member of the board of directors, partner
or individual at the end of the taxable year?
___________________________________________________________________________________________
Retention: Fifty (50) years.

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