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                        New Mailing Address
The mailing address for certain forms have changed 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 Center                                                                                                                       
TE/GE Stop 31A Team 105                                                                                                                                     
P.O. Box 12192                                                                                                                                         
Covington, KY 41042-0192
Deliveries by private delivery service (PDS) should be made to:
Internal Revenue Service Center                                                                                                                             
7940 Kentucky Drive                                                                                                                                          
TE/GE Stop 31A Team 105                                                                                                                                     
Florence, KY 41042
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                                              Request for Miscellaneous 
         Form   (Rev. June 2011)8940                   Determination                                      OMB No. 1545-2211
         Department of the Treasury           Under Section 507, 509(a), 4940, 4942, 4945, and            
         Internal Revenue Service             6033 of the Internal Revenue Code
Use the instructions to complete this form. A User Fee must be attached to this form, if required.  For user fee information or 
additional help, visit our website at www.irs.gov/eo or call IRS Exempt Organizations Customer Account Services toll-free at 
1-877-829-5500.  If the required information and documents are not submitted with payment of the appropriate user fee, the form may 
be returned to you.

Part I   Identification of Organization
1a     Full Name of Organization

b     Address (number, street and room/suite) If a P.O. Box, see instructions.    Cityc                       Stated                  eZip Code + 4

2      Employer Identification Number        3  Month Tax Year 4  Person to Contact if More Information is Needed 
                                              Ends (MM)

5      Contact Telephone Number                                6  Fax Number (optional)                   7  User Fee Submitted

Part II  Type of Request
8     Please select the item(s) below that best describe your request.  Using an attachment, provide a detailed explanation of your request.  Be sure 
      to include the organization's name and EIN on each additional sheet. 
a        Advance approval of certain set-asides described in section 4942(g)(2) 

b        Advance approval of voter registration activities described in section 4945(f) 

c        Advance approval of scholarship procedures described in section 4945(g)

d        Exemption from Form 990 filing requirements 

e        Advance approval that a potential grant or contribution constitutes an “unusual grant”

f        Change in Type (or initial determination of Type) of a section 509(a)(3) organization

g        Reclassification of foundation status, including a voluntary request from a public charity for private foundation status

h        Termination of private foundation status under section 507(b)(1)(B)—advance ruling request

i        Termination of private foundation status under section 507(b)(1)(B)—60-month period ended 

Under penalties of perjury, I declare that I have examined this application, including accompanying statements and schedules, and to the best of my knowledge and belief, it 
is true, correct, and complete.
        ▲
Please  
Sign          (Signature of Officer, Director, Trustee or other authorized official.)                                              (Date) 
Here 

              (Type or print name of signer)                                          (Type or print title or authority of signer) 
For Paperwork Reduction Act Notice, see separate instructions.                        Cat. No. 37756H                              Form 8940 (Rev. 6-2011)