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Part III Technical Requirements
1 Are you filing Form 1023 within 15 months from the end of the month in which your organization was created or formed?

If you answer "Yes" do not answer questions on lines 2 through 7 below.

[X] Yes [.. ] No
2 If one or more of the exceptions to the 15-month filing requirement shown below applies, check the appropriate box and proposal to question 8.
Exceptions - you are not required to file an exemption application within 15 months if the organization

[.. ] a Is a church, interchruch organization of local units of a church, a convention or association of churches, or an integrated anxiliary of a church. See Specific Instructions, Line 2a, on page 4.
[.. ] b Is not a private foundation and normally has gross receipts of not more than $5,000 in each tax year; or
[.. ] c Is a subordinate organization covered by a group exemption letter, but only if the parent or supervisory organization timely submitted a notice covering the subordinate.
3 If the organization does not meet any of the exceptions on line 2 above, are your filing Form 1023 within 27 months from the end of the month in which the organization was created or formed?
If "Yes" your organization qualifies under section 4.01 of Rev Proc 92-85, 1992-2 C.B. 490, for an automatic 12 month extension of the 15-month filing requirement. Do not answer questions 4 though 7.
If "No" answer question 4.
[.. ] Yes [.. ] No
4. If you answer "No" to question 3, has the organization been contacted by the IRS regarding its failure to file Form 1023 within 27 months from the end of the month in which the organization was created or formed?
If "No" your organization is requesting an extension of time to apply under the "reasonable action and good faith" requirements of section 5.01 of Rev Proc 92-85. Do not answer questions 5 through 7.

If "Yes" answer question 5.
[.. ] Yes [.. ] No
5. If you answer "Yes" to question 4, does the organization wish to request relief from the 15-month filing requirement?
If "Yes" give the reasons for not filing this application prior to being contacted by the IRS. See Specific Instructions, Line 5, on page 4 before completing this item. Do not answer questions 6 and 7.
If "No", answer question 6.
[.. ] Yes [.. ] No
6 If you answered "No" to question 5, your organization's qualification as a section 501(c)(3) organization can be recognized only from the date this application is filed with your key District Director. Therefore, do you want us to consider the application as a request for recognition of exemption as a section 501(c)(3) organization from the date the application is received and not retroactively to the date the organization was created or formed?[.. ] Yes [.. ] No
7 If you answered "Yes" to question 6 above and wish to request recognition of section 501(c)(4) status for the period beginning with the date the organization was formed and ending with the date the Form 1023 application was received )the effective date of the organization's section 501(c)(3) status), check here [.. ] and attach a completed page 1 of Form 1024 to this application.