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                           New Mailing Address

The mailing address for certain forms have change since the forms were last published. 
The new mailing address are shown below. 

Mailing Address for Forms 1023, 1024, 1024-A, 1028, 5300, 5307, 5310, 5310-A, 5316, 
8717, 8718, 8940:

Internal Revenue Service   
TE/GE Stop 31A Team 105                              
P.O. Box 12192       
Covington, KY 41012–0192

Deliveries by private delivery service (PDS) should be made to:

Internal Revenue Service 
7940 Kentucky Drive 
TE/GE Stop 31A Team 105 
Florence, KY 41042

This update supplements these forms’ instructions. Filers should rely on this update for 
the change described, which will be incorporated into the next revision of the form’s 
instructions.

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                                    Application for Recognition of Exemption
Form       1028                                 Under Section 521 of the Internal Revenue Code 
(Rev. September 2006)             For the use of farmers', fruit growers', or like associations applying for recognition of         OMB No. 1545-0058
Department of the Treasury                              exemption as  cooperatives.
Internal Revenue Service                              ▶ See separate instructions.
If your organization does not have an organizing document, do not file this application. Every organization must furnish all the information specified 
on the form and in the instructions. An attachment may be used if more space is needed for any item. If the required information and appropriate 
documents are not submitted along with Form 8718 (with payment of the appropriate user fee), the application may be returned to you. 

Part I         Identification 
1a   Full name of organization (See instructions.)                                           b  Employer identification number (See 
                                                                                                instructions.) 

2a   Number, street, and room or suite no. (or P.O. box number if mail is not delivered to street address) 

  b   City or town, county, state, and ZIP code 

3     Name and telephone number (including area code) of person to be                        4  Date incorporated or formed 
     contacted during business hours 
                                                                                             5  Month the annual accounting period ends 

6 a   Has the organization filed Federal income tax returns?  .   .   . .    . .   .     . . .  .        . . .               . .  .       Yes                  No
b     If “Yes,” state the form numbers, years filed, and Internal Revenue office where filed  ▶

Part II        Type of Entity and Organizational Documents (See instructions)
Check the applicable entity box below and attach a conformed copy of the organizing and operational documents listed. 
      Corporation—Articles of Incorporation, bylaws
      Other—Constitution or Articles of Association, bylaws
Part III       Activities and Operational Information
1     Number of shares of each class of capital stock currently outstanding, if any, the value of the consideration for which issued, 
      and the rate of dividend paid:                                           Shares                      Amount                   Rate of Dividend 
a     Preferred stock (voting)  .   . .       . . . . . . .       1a 
b     Preferred stock (nonvoting)  .  .       . . . . . . .       1b 
c     Common stock (voting)  .      . .       . . . . . . .       1c 
d     Common stock (nonvoting)  .     .       . . . . . . .       1d 
2     Number of shares of capital stock (other than nonvoting preferred) owned by: 
a     Producers          .  . . . . . .       . . . . . . . .     .   . .    . .   .     . . .  .        . . .               .   2a 
b     Nonproducers  .         . . . . .       . . . . . . . .     .   . .    . .   .     . . .  .        . . .               .   2b 
c     Current and active producers  .         . . . . . . . .     .   . .    . .   .     . . .  .        . . .               .   2c 
d     Total number of shares—Add lines 2a and 2b .      . . .     .   . .    . .   .     . . .  .        . . .               .   2d 
e     Percentage owned by current and active producers—Divide line 2c by line 2d  .          .  .        . . .               .   2e                            % 
3     What provision is made for retiring the voting stock held by a nonproducer? 

4    Describe who is accorded voting rights in the cooperative and how many votes one person may have. If a person may be 
      entitled to more than one vote, explain in detail how voting rights are acquired. 

5     Legal rate of interest in the state where the association is located  .  .   .     . . .  .        . . .               .   ▶
           Under penalties of perjury, I declare that I am authorized to sign this application on behalf of the above organization; and I have examined this application,
Please     including the accompanying statements, and to the best of my knowledge and belief it is true, correct, and complete. (See General Instruction “C.”) 
Sign          ▲
Here 
                                  (Signature)                             (Title or authority of signer)                                  (Date) 
For Paperwork Reduction Act Notice, see page 2 of the separate instructions.               Cat. No. 17138N                          Form  1028  (Rev. 9-2006) 

Form 1028 (Rev. 9-2006)                                                                                                          Page  2 
Part III Activities and Operational Information (Continued)
6      If the association issues any nonvoting preferred stock, explain whether the owners, upon dissolution or liquidation, may 
       participate in the profits of the association beyond fixed dividends. 

7a     Does state law require the accumulation and maintenance of reserves?  .         . . . . . . . . . .          .     Yes    No
b      If “Yes,” state the names and purposes of the reserves and enter the amount of each:                               Amount 

8 a    Does the association maintain or plan to maintain any reserve or reserves other than those required by 
       state law?.      . . . . .      . . . . .  .  .   . . . .     . .     . .     . . . . . . . . . . .  .             Yes    No
b      If “Yes,” state the names and purposes of the reserves and enter the amount of each:                               Amount 

9      Does the association deal or plan to deal with both members and nonmembers?  .        . . . . . . .  .             Yes    No
10a    Does the association pay or plan to pay patronage dividends?  .       . .     . . . . . . . . . . .  .             Yes    No
b      If “Yes,” are they paid or will they be paid to all patrons, both member and nonmember, on the same basis? . .     Yes    No
11a    Is the allocation of patronage dividends based on an obligation in existence before the cooperative 
       received the amounts allocated?  .    . .  .  .   . . . .     . .     . .     . . . . . . . . . . .  .             Yes    No
b      If “Yes,” is the obligation in: 
         Organizing document (specify) ▶
         Bylaws
12     Explain all of the activities in which the association is or will be engaged. 

13    Explain how distribution is or will be made of the proceeds of products marketed for members and nonmembers. Also, if  the 
      organization  operates  on  a  basis  of  allocated  units  (i.e.,  functional,  departmental,  etc.),  explain  how  losses  are  or  will 
      be treated. 

14     Explain how the association charges for supplies and equipment bought for members and nonmembers. 

                                                                                                                    Form  1028  (Rev. 9-2006) 

Form 1028 (Rev. 9-2006)                                                                                                         Page  3 
Part III   Activities and Operational Information (Continued)
15     Explain the requirements for membership in the association. 

16     Federated cooperatives only: 
a      Are all the association’s member cooperatives exempt under section 521?  .   . .      . . . . . . .      .           Yes No
b      If  “No,”  do  the  nonexempt  member  cooperatives  have  the  same  annual  accounting  period  as  the 
       association’s?  . .      . .   . . . . .  . . .     .   .  . .  . . .   .  . . .      . . . . . . .      .           Yes No
c      If “No,” to 16b, check the method below that the association used, or will use, to provide a common or comparable unit of 
       time for analyzing and evaluating its operations and those of its members. 
       Note: Methods listed below do not apply to the filing of returns or the manner in which operating results are reported by a 
       federated cooperative and its members. 
       1.   Method 1—The association uses the operations of members for those months that correspond to the months that 
            make up its tax year. 
       2.   Method 2—The association uses the tax years of members that end within its tax year. 
       3.   Method other than 1 or 2 above (explain) ▶

17     Value of agricultural products marketed or handled  Current tax   
                                                                                               3 prior tax years 
       for: (See instructions.)                                   year 
                                                           (a) From        (b)                 (c)                      (d) 
*a     Members—                                                to 
       1.  Actually produced by members  
       2.  Not actually produced by members but  
          marketed by them through the association  
b      Nonmembers— 
       1.  Actually produced by nonmembers  
       2.  Not actually produced by nonmembers but  
          marketed by them through the association  
c      Nonproducers  (purchased  from  nonproducers 
       for marketing by the association)  . . .  . .
18     Value of supplies and equipment purchased for 
       or sold to: (See instructions.)
*a     Members who were producers .       . . .  . .
b      Nonmembers who were producers        . .  . .
c      Members and nonmembers who were not producers 
19     Amount of business done with the United States  
       Government or any of its agencies    . .  . .
20     Does the association plan to do business with the United States Government or any of its agencies in the future?     Yes No
21a    Were all of the net earnings (after payment of dividends, if any, on capital stock) for the years shown on 
       lines 17–19 distributed as patronage dividends? (See instructions for lines 17–19.) . . . . . . . .      .           Yes No
b      If “No,” were undistributed net earnings apportioned on the records to all patrons on a patronage basis?             Yes No
22a    Has the organization operated in a manner consistent with the information given since the date formed?               Yes No
b      If “No,” state the changes that have occurred and dates of the changes. 

*If it is necessary to own one or more shares of stock in order to become a member, include on lines 17a and 18a only the amount 
of business transacted with persons actually owning the required number of shares. 
                                                                                                                Form  1028  (Rev. 9-2006) 

Form 1028 (Rev. 9-2006)                                                                                                                                                            Page  4 
Part IV                                               Financial Data (See instructions.)
                                                      Complete the Statement of Receipts and Expenditures and Balance Sheets for the current year and for each of the 
                                                      three immediately preceding years that the organization was in existence. 
Statement of Receipts and Expenditures, for period ending                                                                                                               ,                     . 
(If you prepare a statement of receipts and expenditures that is more descriptive and detailed than the statement below, you 
may submit that statement instead of this one.) 
                                                  1   Gross dues and assessments from members  .           . .   . .   . .   .      . . .  .  .    .           . . .    1 
                                                  2   Gross dues and assessments from affiliated organizations .       . .   .      . . .  .  .    .           . . .    2 
                                                  3 a Gross amount derived from activities related to organization’s exempt 
                                                      purpose (attach schedule)     . . .    . .    .    . . .   . .   . .   .      .   3a 
                                                  b   Less cost of goods sold  .    . . .    . .    .    . . .   . .   . .   .      .   3b  (                         ) 3c 
                                                  4a  Gross amount from other business activities (attach schedule)      .   .      .   4a 
                                                  b   Less cost of goods sold  .    . . .    . .    .    . . .   . .   . .   .      .   4b  (                         ) 4c 
             Receipts                             5 a Gross amount received from sale of assets, excluding inventory items 
                                                      (attach schedule) . .    .    . . .    . .    .    . . .   . .   . .   .      .   5a 
                                                  b   Less cost or other basis and sales expense of assets sold (attach schedule)       5b  (                         ) 5c 
                                                  6   Interest, dividends, rents and royalties .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    6 
                                                  7   Other receipts (attach schedule)  .    . .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    7 
                                                  8   Total receipts—Add lines 1 through 7 in far right column  .      . .   .      . . .  .  .    .           . . .    8 
                                                  9   Compensation of officers, directors, and trustees (attach schedule)  .        . . .  .  .    .           . . .    9 
                                                  10  Other salaries and wages .    . . .    . .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    10 
                                                  11  Interest . .  . . . .    .    . . .    . .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    11 
                                                  12  Rent . .   .  . . . .    .    . . .    . .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    12 
                                                  13  Depreciation and depletion  .   . .    . .    .    . . .   . .   . .   .      . . .  .  .    .           . . .    13 
                                                  14  Dues and assessments to affiliated organizations .     .   . .   . .   .      . . .  .  .    .           . . .    14 
             Expenditures                         15  Other expenditures (see instructions—attach schedule) .      .   . .   .      . . .  .  .    .           . . .    15 
                                                  16  Patronage dividends (see instructions—attach schedule)  .        . .   .      . . .  .  .    .           . . .    16 
                                                  17  Total expenditures—Add lines 9 through 16  .         . .   . .   . .   .      . . .  .  .    .           . . .    17 
                                                  18  Excess of receipts over expenditures (line 8 less line 17)   .   . .   .      . . .  .  .    .           . . .    18 
                                                                                                                                      Enter                    Beginning date     Ending date 
Balance Sheets                                                                                                                        dates  ▶
                                                  19  Cash   .   .  . . . .    .    . . .    . .    .    . . .   . .   . .   .      . . .     19 
                                                  20  Trade notes and accounts receivable (less allowance for bad debts)            . . .     20 
                                                  21  Inventories   . . . .    .    . . .    . .    .    . . .   . .   . .   .      . . .     21 
                                                  22  Investments (attach schedule)  .  .    . .    .    . . .   . .   . .   .      . . .     22 
                                                  23  Other current assets (attach schedule)   .    .    . . .   . .   . .   .      . . .     23 
             Assets                               24  Depreciable and depletable assets (less accumulated depreciation/depletion)             24 
                                                  25  Land (net of any amortization)  . .    . .    .    . . .   . .   . .   .      . . .     25 
                                                  26  Other assets (attach schedule)  . .    . .    .    . . .   . .   . .   .      . . .     26 
                                                  27  Total assets  . . . .    .    . . .    . .    .    . . .   . .   . .   .      . . .     27 
                                                  28  Accounts payable  . .    .    . . .    . .    .    . . .   . .   . .   .      . . .     28 
                                                  29  Mortgages, notes, bonds payable in less than one year  .     .   . .   .      . . .     29 
                                                  30  Other current liabilities (attach schedule) . .    . . .   . .   . .   .      . . .     30 
                                                  31  Mortgages, notes, bonds payable in one year or more  .       .   . .   .      . . .     31 
                                                  32  Other liabilities (attach schedule)  . . .    .    . . .   . .   . .   .      . . .     32 
                                                  33  Patronage dividends allocated in noncash form, other than capital stock and 
                                                      interest-bearing obligations  . . .    . .    .    . . .   . .   . .   .      . . .     33 
                                                  34  Per-unit retains allocated in noncash form  .      . . .   . .   . .   .      . . .     34 
                                                  35  Capital  stock  (enter  numbers  at                                Number of shares 
                                                      end of year):                                   Number of  
                                                                                                    shareholders       Issued for       Issued as  
                                                                                                                       money            patronage benefits                        
                                                  a   Voting preferred stock . .    . .      35a 
                          Liabilities and Capital b   Nonvoting preferred stock     . .      35b 
                                                  c   Voting common stock  .   .    . .      35c 
                                                  d   Nonvoting common stock        . .      35d 
                                                  36  Paid-in or capital surplus  . . . .    . .    .    . . .   . .   . .   .      . . .     36 
                                                  37  Retained earnings (attach schedule)  .   .    .    . . .   . .   . .   .      . . .     37 
                                                  38  Less cost of treasury stock  .  . .    . .    .    . . .   . .   . .   .      . . .     38    (                         )  (                         ) 
                                                  39  Total liabilities and capital . . .    . .    .    . . .   . .   . .   .      . . .     39 
                                                                                                                                                                        Form  1028  (Rev. 9-2006)