Form (Rev. September 2015) Department of the Treasury Internal Revenue Service 1 Name of organization 8718 OMB No. 1545-1798 For IRS Control number Use Attach this form to determination letter application. Amount paid Only (Form 8718 is NOT a determination letter application.) User fee screener 2 Employer Identification Number User Fee for Exempt Organization Determination Letter Request 3 a Caution. Do not attach Form 8718 to an application for a pension plan determination letter. Use Form 8717 instead. Type of request Initial request for a determination letter for: � An exempt organization that has had annual gross receipts averaging not more than $10,000 during the preceding 4 years or � A new organization that anticipates gross receipts averaging not more than $10,000 during its first 4 years Note. If you checked box 3a, you must complete the Certification below. Fee $400 Certification I certify that the annual gross receipts of name of organization have averaged (or are expected to average) not more than $10,000 during the preceding 4 (or the first 4) years of operation. b Signature Title Initial request for a determination letter for: � An exempt organization that has had annual gross receipts averaging more than $10,000 during the preceding 4 years or � A new organization that anticipates gross receipts averaging more than $10,000 during its first 4 years . Group exemption letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . Internal Revenue Service P.O. Box 12192 Covington, KY 41012-0192 c $850 $3,000 Instructions The law requires payment of a user fee with each application for a determination letter. The user fees are listed on line 3 above. For more information, see Rev. Proc. 2015-8, 2015-1 I.R.B. 235, or latest annual update. Check the box or boxes on line 3 for the type of application you are submitting. If you check box 3a, you must complete and sign the certification statement that appears under line 3a. Attach to Form 8718 a check or money order payable to the "United States Treasury" for the full amount of the user fee. If you do not include the full amount, your application will be returned. Attach Form 8718 to your determination letter application. Generally, the user fee will be refunded only if the Internal Revenue Service declines to issue a determination. Who Should File Organizations applying for federal income tax exemption, other than filers of Form 1023, Application for Recognition of Exemption Under Section 501(c)(3), or Form 1023-EZ (filed only electronically), should file Form 8718. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. If you want your organization to be recognized as tax-exempt by the IRS, you are required to give us this information. We need it to determine whether the organization meets the legal requirements for tax-exempt status. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The rules governing the confidentiality of Form 8718 are covered in section 6104. The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is 5 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making this form simpler, we would be happy to hear from you. You can send us comments from www.irs.gov/formspubs. Click on "More Information" and then on "Give us feedback." Or you can send your comments to the Internal Revenue Service, Tax Forms and Publications, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send the form to this address. Instead, see Where To File, above. Where To File Send the determination letter application and Form 8718 to: Cat. No. 64728Z Form 8718 (Rev. 9-2015) American LegalNet, Inc. www.FormsWorkFlow.com