501c3 Application Starter

501c3 Application Starter

This form is to be used to assist us in completing your 1023EZ application. We understand that you may not be able to answer all the questions at this time. If you have to skip or enter N/A for questions that you are unable to answer we will reach out to you and assit.
Responsible Party`s Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Organization`s Name (or CHOICE 1 Name if not yet incorporated)*
CHOICE 2 Name if not yet incorporated*
Address or Organization (If Different from Responsible Party Address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please provide your Social Security Number for the Responsible Party
Would you like to provide your Social Security number via phone instead

Yes. Please call me to obtain itNo. I have provided my social using this form
Please provide the names and andresses of AT LEAST 3 board members. It is recommended that the Executive Director Not serve as a board member.
Name (Board Member) 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name ( Board Member ) 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name (Board Member) 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
You may add additional board member (s) name (s) and addresses here. Also use the space to describe titles (if any) of these and other (above named) board members
Describe your planned activities in a narrative.*
Section B
I understand that the IRS User Fee, state fees and filing fees for the 1023EZ is included in my service fee.*

YesNoDoes Not Apply
You understand (Coach Erika Perry/Perry`s Empowering Services) is not a funding agency and that recepit of nonprofit exempt status DOES NOT in any way guarantee funding*

YesNo
You understad that payments recevied are non-refundable.*

YesNo
You understand that by making a payment, you are requesting that Perry`s Empowering Services assist you/your organization with the 1023 Application and Federal Tax Exemption process.*

YesNo
You understand that your application (project) will be addresed in the order received*

YesNo
You understand that failure on behalf of you/your organization to provide Perry`s Empowering Services with requested information within a resonable time will delay expected deliverables.*

YesNo
You understand that this service does not include fundrasing registration (where required), DUNS or SAM registration.*

YesNo
You understand that fundrasing registration, DUNS or SAM registration is a separate service and available upon new service agreement.*

YesNo
You understand that Perry`s Empwering Services is NOT your state incorpation agency and is not the Federal IRS. You understand that Perry`s Empowering Services does not have the authority to control over the state or federal processing times, application review procedures or processes.*

YesNo
Your signature confirms that you understand the terms of this agreement and are the authorized representative of this organization.*
Should be Empty:

501c3 Application Starter

Please provide the names and andresses of AT LEAST 3 board members. It is recommended that the Executive Director Not serve as a board member.

Section B