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1 Are you filing Form 1023 within 15 months from the end of the month in which you were created or formed? If you answer "Yes," do not answer questions 2 through 6. Ga Yes \ Pop \ \ oNo \ \ . 'orm 1023 (Rev, 9-90) ImDI ' Technical Requirements 2 If one of the exceptions to the IS-month filing requirement shown below applies, check the appropriate box and proceed to question 7. Exceptions-You are not required to file an exemption application within 15 months if the orgal')ization: o (8) Is a church, interchurch organization, local unit of a church, a convention or association of churches, or an integrated auxiliary of a church; o (b) Is not a private foundation and normally has gross receipts of not more than $5,000 in each tax year; or, o (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 you do not meet any of the exceptions in question 2, do you wish to request relief from the IS-month filing requirement? . . . . . . . . . . , . . . . . . . . . . . . . . . '. . . . . . 0 Yes oNo 4 If you answer "Yes. to question 3, please give your reasons for not filing this application .....ithin IS months from the end of the month in which your organization was created or formed. (See the Instructions before completing this item.) 5 If you answer "No. to both questions 1 and 3 and do not meet any of the exceptions in question 2, your 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 your application as a request for recognition of exemption as a section 501(cX3) organization from the date the application is received and not retroactively to the date you were formed? . . . . . . . . . . . . . . , , . , . 0 Yes DNo 6 If you answer "Yes" to question 5 above and wish to request recognition of section SO 1 (cX4) status for the period beginning with the date you were formed and ending with the date your Form 1023 application was received (the effective date of your section 501(cX3) status), check here .0 and attach a completed page 1'of Form 1024 to this application.