501(C)(3) Authorization Form printable pdf download

501(C)(3) Authorization Form

501(c)(3) Authorization

For first time application, this form must be accompanied with the “Request to be Included” form

xx-xxxxxxx

FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN):

Please enter EIN for your church here.

NOTE: If your church does not have its own

EIN, please complete IRS Form SS-4.

Please check one of the following two options:

Church Name located in City*, State, hereby authorizes the Evangelical Free Church of

America (EFCA) to include said church in its listing of subordinate organizations for

recognition of federal tax exemption under section 501(c)(3) of the Internal Revenue Code,

group exemption number 1729.

Please note that you can be covered by only one 501(c)(3) recognition at a

time and that by agreeing to be included in the EFCA group exemption, any prior recognition by the IRS of federal

tax exempt status shall be nullified.

Church Name located in City*, State, hereby does not authorize the EFCA to include said

church in its listing of subordinate organizations for recognition of federal tax exemption under

Section 501(c)(3) of the Internal Revenue Code.

Please note we use the mailing address city as the location city.

Additional information (Please complete only if applicable):

Church Name by this or any other name, has previously received a ruling or determination letter

from the Internal Revenue Service relating to its federal tax-exempt status:

(1)

By filing IRS Form 1023 Application for Recognition of Exemption Under Section

501(c)(3) of the Internal Revenue Code.

Issue date of ruling or determination letter: ________________________



(2)

By coming under that of another organization (other than the EFCA) under Section

501(c)(3) of the Internal Revenue Code.

Group exemption number ____________________



Previous name ______________________________________



Signature

Title

Print Name

Date Signed

For Internal Use Only

IRS Report Date

Reason for Inclusion/Notes

Status

CMDS #

Version 071304

501(C)(3) Authorization Form

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