Form Ar1023ct - Application For Income Tax Exempt Status

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AR1023CT

STATE OF ARKANSAS

CORPORATION INCOME TAX SECTION

Application for Income Tax Exempt Status

PART I

Identification of Applicant

1a Full Name of Organization ( As shown in organizing document)

FEIN

1b C/O Name (If applicable)

Name and telephone number of person to be

contacted if additional information is needed.

1c Address (Number, Street and Room or Suite Number)

(

)

1d City or Town, State and ZIP Code

Tax Year (Month/Year)

6 Activity Codes (See Instructions)

05 Date Incorporated or Formed

List subsection of ACA 26-51-303(a) applying under

08 Date began activity in Arkansas

9 Domestic or Foreign

10 IRC Exempt Under

11 IRS Approval Date

12 IRS Expiration Date

13 Has the organization filed Arkansas Corporation Income Tax Returns? .............................................................................................................

Yes

(If “Yes”, state the tax years filed).

14 Check the box for your type of organization.

BE SURE TO ATTACH A COMPLETE COPY OF THE CORRESPONDING DOCUMENTS TO THE APPLICATION BEFORE MAILING.

Corporation:

Attach a copy of your Articles of Incorporation (including amendments and restatements) showing approval by the appropriate State

official; also include a copy of your Bylaws.

Trust:

Attach of copy of your Trust Indenture or Agreement, including all appropriate signatures and dates.

Cooperative:

Attach a copy of your creating documents and a copy of your Bylaws, Rules and Regulations.

Partnership:

Attach a copy of your Partnership Agreement and Bylaws if any.

Association:

Attach a copy of your Articles of Association, Constitution, or other creating documents, with a declaration or other evidence the

organization was formed by adoption of the document by more than one person; also include a copy of your Bylaws.

If you are a corporation or an unincorporated association that has not yet adopted Bylaws, check here...................................................................................

I declare under the penalties of perjury that I am authorized to sign this application on behalf of the organization and that I have examined this application, including

the accompanying schedules and attachments, and to the best of my knowledge, it is true, correct and complete.

Please

Sign

Here

___________________________________________

_________________________________________

_____________________

Signature

Title or Authority of Signer

Date

Revised 9/97

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