Application for Exemption from Self-Employment
Tax for Use by Ministers, Members of Religious
Parr Revenge Service” Orders and Christian Science Practitioners
Documentation required by Specific Instruction Item 4 MUST be attached to this form. Before filing this form see General Instructions.
2 Social security number

rom 4361

(Rev. September 1981)

OMB No. 1545-0168
Expires 8/31/84

1 Name

Address

City or town, State and ZIP code

Please type or print

3 Check ONLY ONE box: [7] Christian Science practitioner 4 Date ordained, licensed, etc.

[[] Member of religious order not under a vow of poverty

([] Ordained minister, priest, rabbi
[[] Commissioned or licensed minister (see Item 7)

5 Legal name of ordaining, licensing, or commissioning body or religious order Employer identification number

Address

City or town, State and ZIP code

6 Enter the first two years after the date entered in Item 4, above, in which you had net earnings from self-employ-
ment of $400 or more, some part of which was from services as'a minister, priest, rabbi, etc.; or as a member of
a religious order; or as a Christian Science practitioner . . . ee 19 19
Caution: Form 4361 is not proof of any of the following: (a) the right to an ‘exemption from Federal income tax withholding and
social security tax; (b) the right to a parsonage allowance exclusion (section 107 of the Interna! Revenue Code); or (c)
assignment by your religious superiors to a particular job.

7 If you are applying for the exemption as a licensed or commissioned minister, and your denomination provides for the ordination of ministers,
please indicate to what extent your ecclesiastical powers differ from those of an ordained minister of your denomination and attach a copy of your
denomination’s by-laws relating to the powers of ordained, and commissioned or licensed ministers.

8 | certify that, because of my religious principles, | am conscientiously opposed to the acceptance (with respect to services performed by me as a

minister, member, or practitioner) of the benefits of any public insurance that makes payments in the event of death, disability, old-age, or
retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system estab-

lished by the Social Security Act).

| certify that 1 did not file an effective waiver certificate (Form 2031) electing social security coverage on earnings as a minister, member, or

practitioner.

| hereby request an exemption from payment of self-employment tax with respect to my earnings from services as a minister, member, or

practitioner, pursuant to the provisions of section 1402(e) of the Internal Revenue Code.

1 understand that the exemption, if granted, ‘will

apply only to such earnings. Under penalties of perjury, | declare that this application has been examined by me and to the best of my knowledge

and belief it is true and correct.

Signature >

Date >

Note: The exemption is granted only if the application is approved by Internal Revenue Service, and Copy C is returned to you marked “approved.”

For Internal Revenue Service Use
( Approved for exemption from self-employment tax (see Caution above)
(1 _Disapproved for exemption from self-employment tax

By ....

(Wirector’s signature)

COPY C
To be
returned to
taxpayer

(ate)

General Instructions

This form must be filed in triplicate with the

Internal Revenue Service.
Paperwork Reduction Act Notice.—The
Paperwork Reduction Act of 1980 says
we must tell you why we are collecting
this information, how we will use it, and
whether you have to give it to us. We ask
for the information to carry out the Internal
Revenue laws of the United States. We need
it to ensure that you are complying with
these laws and to allow us to figure and col-
lect the right amount of tax. You are re-
quired to give us this information.

If you are a member of a religious order who
has taken a vow of poverty, do not file this form
because you are automatically exempt from the
payment of self-employment tax for amounts
earned for services performed for your church
or an integral agency thereof. However, members
of a religious order who are under a vow of pov-
erty and are paid to perform services for an

organization other than the church or an integral
agency of it are treated as regular employees of
this organization for Federal employment tax
purposes (Federal income tax withholding, social
security and Federal unemployment tax). The
automatic exemption from self-employment tax
does not apply to amounts earned during such
employment.

A. Purpose of This Form.—This form
should be used to request exemption under
the Self-Employment Contributions Act for
services performed by a minister, member
of a religious order, or Christian Science
practitioner.

B. Who May File for Exemption.—Any
duly ordained, commissioned, or licensed
minister of a church, member of a religious
order (who has not taken the vow of
poverty), or Christian Science practitioner
may file for exemption from seif-employ-
ment tax. To be eligible for the exemption,
the applicant must establish that the or-

daining, commissioning, or licensing body
(or religious order) is a church that is ex-
empt from Federal income tax under sec-
tion 501(a) of the Internal Revenue Code
as a religious organization described in
section 501(c)(3), and must also establish
that the church (or convention or associa-
tion of churches) is one described in sec-
tion 170(b)(1)(A)(i). The request must be
based on a conscientious opposition, be-
cause of the applicant's religious princi-
ples, to accepting (for services performed
as a minister, member, or practitioner)
public insurance (including social security
benefits) that makes payments in the event
of death, disability, old-age, or retirement
or makes payments toward the cost of, or
provides services for, medical care. How-
ever, if the minister, member, or practi-
tioner has previously filed an effective
waiver certificate Form 2031, an applica-
tion for exemption may NOT now be filed.

Commissioned or licensed ministers of
a church or church denomination that pro-
(Continued on back)



vides for ordination of ministers may file
an application for exemption if they are
invested with the authority to perform sub-
stantially all of the religious duties of their
church or church denomination.

For more information, see Publication
517, Social Security for Members of the
Clergy and Religious Workers.

C. Earnings to Which This Exemption
Applies.—An exemption that is effective
for a duly ordained, commissioned, or li-
censed minister of a church applies only to
service performed in the exercise of the
ministry.

Service performed by a minister in the
exercise of the ministry includes the min-
istration of sacerdotal functions, the con-
duct of religious worship, and the control,
conduct, and maintenance of religious or-
ganizations (including the religious boards,
societies, and other integral agencies of
such organizations), under the authority of
a religious body constituting a church or
church denomination. The following rules
apply in determining whether services per-
formed by a minister are performed in the
exercise of the ministry.

If a minister is performing service in
the conduct of religious worship or the
ministration of sacerdotal functions, this
service is in the exercise of the ministry
whether or not it is performed for a reli-
gious organization.

If a minister is performing service for an
organization that operates as an integral
agency of a religious organization under
the authority of a religious body constitut-
ing a church or church denomination, all
service performed by the minister in the
conduct of religious worship, in the minis-
tration of sacerdotal functions, or in the
control, conduct, and maintenance of such
organization is in the exercise of the min-
istry. The following example illustrates
this rule:

Example: M, a duly ordained minister, is en-
gaged by the N Religious Board to serve as director
of one of its departments. M performs no other
service. The N Religious Board is an integral
agency of 0, a religious organization operating
under the authority of a religious body constituting
a church denomination, M is performing service in
the exercise of M's ministry.

If a minister, under an assignment or
designation by a religious body constitut-
ing the minister's church, performs service
for an organization that is neither a reli-
gious organization nor operated as an inte-
gral agency of a religious organization, all
service performed by the minister, even
though this service may not involve the
conduct of religious worship or the min-
istration of sacerdotal functions, is in the
exercise of the ministry. Ordinarily, the
services of a minister are not assigned or
designated services if any of the following
circumstances are present: (1) the organi-
zation for which the minister performs the
services did not arrange with the minister's
church for the minister's services; (2) the
minister is performing services for the or-
ganization that other employees of the or-
ganization who have not been so desig-
nated are performing; or (3) the minister
performed the same services before and
after the designation.

D. Earnings to Which This Exemption
Does Not Apply.—An exemption that is ef-
fective for a duly ordained, commissioned,
or licensed minister of a church does not
apply to service performed that is not in
the exercise of the ministry.

If a minister is performing service for an
organization that is neither a religious
organization nor operated as an integral

agency of a religious organization and the
service is not performed under an assign-
ment or designation by the minister's ec-
clesiastical superiors, then only the service
performed by the minister in the conduct
of religious worship or the ministration
of sacerdotal functions is in the exercise of
the ministry. The following example illus-
trates this rule:

Example: M, a duly ordained minister, is en-
gaged by N University to teach history and mathe-
matics. M performs no other service for N al-
though from time to time M performs marriages
and conducts funerals for relatives and friends.
N University is neither a religious organization
nor operated as an integral agency of a religious
organization. M is not performing the service for
N under an assignment or designation by M's
ecclesiastical superiors. The service performed by
M for N University is not in the exercise of M's
ministry. However, service performed by M in per-
forming marriages and conducting funerals is in
the exercise of M's ministry.

Service performed by a duly ordained,
commissioned, or licensed minister of a
church as an employee of the United
States, or a State, territory, or possession
of the United States, or the District of
Columbia, or a foreign government, or a
political subdivision of any of the fore-
going, is not considered to be in the exer-
cise of the ministry for purposes of the tax
on self-employment income, even though
this service may involve the ministration
of sacerdotal functions or the conduct of
religious worship. For example, service
performed by a chaplain in the Armed
Forces of the United States is considered
to be performed by a commissioned officer
in this capacity and not by a minister in
the exercise of the ministry. Similarly,
service performed by a chaplain in a State
prison or State University is considered to
be performed by a civil servant of the State
and not by a minister in the exercise of the
ministry.

E. Time Limitation for Filing Application
for Exemption.—An application for ex-
emption must be filed with the Internal
Revenue Service by the later of the two
following dates: (1) the due date of your
tax return (including extensions) for the
second tax year in which you have net
earnings from self-employment of $400 or
more, any part of which was derived from
services as a minister, member of a reli-
gious order or Christian Science practi-
tioner; or (2) the due date (including ex-
tensions) of your tax return for your second
tax year ending after 1967.

Example: Reverend Aker, ordained in 1965, had
net ministerial earnings of $400 or more in all
years after 1965 and had not filed a waiver certifi-
cate electing social security coverage (Form 2031).
He should have filed an application for exemption
by April 15, 1970, or extended date.

Reverend Beeker, ordained in 1978, had ministe-
rial income of $400 or more in 1978 and in 1979.
He should have filed an application for exemption
not later than April 15, 1980, or extended date.

F. Effective Date of Exemption.—An ex-
emption from self-employment tax is effec-
tive for the first tax year ending after 1967,
and all succeeding tax years in which you
have net earnings from self-employment of
$400 or more, any part of which is derived
from services as a minister, member, or
Practitioner. Thus, if you had qualified net
earnings of $400 or more in 1968 and not
again until 1979, a valid application for
exemption from self-employment tax filed
by April 15, 1980, would be effective for
1968 and all years thereafter. However,
contact an IRS office to see if you are en-
titled to file a claim for refund of self-em-
ployment taxes paid in prior tax years.

G. Where to File.—Mail your application
to the Internal Revenue Service Center for
the place where you live.

New Jersey, New York City
and counties of Nassau,

Rockland, Suffolk, and 00501
Westchester
New York (ail other counties),
Connecticut, Maine,
Massachuselts, New ‘Andover, MA 05501
Hampshire, Rhode Island,
Vermont
Alabama, Florida, Georgia,
Mississippi, South Carolina Atlanta, GA 31101
Michigan, Ohuo Cincinnati, OH 45999
Louisiana. New Mexico,
Arkansas, Kansas, Austin, TX 73301
Oklahoma, Texas’
‘Alaska, Arizona, Colorado,
\daho, Minnesota, ‘Montana,
Nebraska, Nevada, North
agen South Ogden, UT 84201
tah, Washington,
Wyoming
Tilinots, 1owa, Missouri, Kansas City, MO 64999
Wisconsin
Califorma, Hawaii Fresno, CA_ 93868,
Indiana, Kentucky, North -
Carolina, Tennessee, Memphis, TN 37501

Virginia, West Virginia

Delaware, District of
Columbia, Maryland,
Pennsylvania

Philadelphia, PA 19255

If you have no legal residence in the United
States then mail this form to the Internal Reve-
nue Service Center, Philadelphia, PA 19255.

H. Extensions of Time for Filing and
Noncalendar Year Taxpayers.—In general,
the filing dates stated do not apply if yor:
file your tax return for other than a calen-
dar year or you are granted an extension
of time to file your return. Contact the near-
est Internal Revenue Service office for ap-
plicable dates.

1. How to Indicate Exemption on Form
1040.—If your only income subject to self-
employment tax is from ministerial serv-
ices, and Copy C has been returned to you
approved by the Internal Revenue Service,
write ‘‘Exempt-Form 4361” on the self-em-
ployment line in Other Taxes section of
Form 1040. However, if you have other
income subject to self-employment tax, see
Schedule SE (Form 1040).

J. Revocation of Exemption.—You may
not revoke the exemption once it is re-
ceived.

Specific Instructions

Item 2.—Enter your social security
number as it appears on your social secu-
rity card. If you have no number, file ap-
plication Form SS-5 with the local office
of the Social Security Administration. If
you do not receive your card in time, file
Form 4361 and enter “Applied for’’ in the
space provided for the number.

Item 4.—Enter the date you were duly
ordained, commissioned, or licensed as a
minister of a church, or date you became
a member of a religious order, or date you
commenced practice as a Christian Science
practitioner. No application for exemption
should be filed prior to this date. A copy of
the certificate (or a letter from the govern-
ing body of your church if you did not re-
ceive a certificate) establishing your status
as a duly ordained, commissioned, or a li-
censed minister, or a member of a religious
order, or Christian Science practitioner,
must be attached to the form.

Item 5.-—if you are a minister or a mem-
ber of a religious order, enter the legal
name, address, and employer identification
number of the church denomination that
ordainec, commissioned, or licensed you
or the order of which you are now a mem-
ber. The employer identification number
should be obtained from the ordaining,
licensing, or commissioning body or reli-
gious order.



vides for ordination of ministers may file
an application for exemption if they are
invested with the authority to perform sub-
stantially all of the religious duties of their
church or church denomination.

For more information, see Publication
517, Social Security for Members of the
Clergy and Religious Workers,

C. Earnings to Which This Exemption
Applies.—An_ exemption that is effective
for a duly ordained, commissioned, or li-
censed minister of a church applies only to
service performed in the exercise of the
ministry.

Service performed by a minister in the
exercise of the ministry includes the min-
istration of sacerdotal functions, the con-
duct of religious worship, and the control,
conduct, and maintenance of religious or-
ganizations (including the religious boards,
societies, and other integral agencies of
such organizations), under the authority of
a religious body constituting a church or
church denomination. The following rules
apply in determining whether services per-
formed by a minister are performed in the
exercise of the ministry.

If a minister is performing service in
the conduct of religious worship or the
ministration of sacerdotal functions, this
service is in the exercise of the ministry
whether or not it is performed for a reli-
gious organization.

If a minister is performing service for an
organization that operates as an integral
agency of a religious organization under
the authority of a religious body constitut-
ing a church or church denomination, all
service performed by the minister in the
conduct of religious worship, in the minis-
tration of sacerdotal functions, or in the
control, conduct, and maintenance of such
organization is in the exercise of the min-
istry. The following example illustrates
this rule:

Example: M, a duly ordained minister, is en-
gaged by the N Religious Board to serve as director
of one of its departments. M performs no other
service. The N Religious Board is an integral
agency of 0, a religious organization operating
under the authority of a religious body constituting
a church denomination. M is performing service in
the exercise of M’s ministry.

If a minister, under an assignment or
designation by a religious body constitut-
ing the minister's church, performs service
for an organization that is neither a reli-
gious organization nor operated as an inte-
gral agency of a religious organization, all
service performed by the minister, even
though this service may not involve the
conduct of religious worship or the min-
istration of sacerdotal functions, is in the
exercise of the ministry. Ordinarily, the
services of a minister are not assigned or
designated services if any of the following
circumstances are present: (1) the organi-
zation for which the minister performs the
services did not arrange with the minister's
church for the minister’s services; (2) the
minister is performing services for the or-
ganization that other employees of the or-
ganization who have not been so desig-
nated are performing; or (3) the minister
performed the same services before and
after the designation.

D. Earnings to Which This Exemption
Does Not Apply.—An exemption that is ef-
fective for a duly ordained, commissioned,
or licensed minister of a church does not
apply to service performed that is not in
the exercise of the ministry.

If a minister is performing service for an
organization that is neither a religious
organization nor operated as an integral

agency of a religious organization and the
service is not performed under an assign-
ment or designation by the minister’s ec-
clesiastical superiors, then only the service
performed by the minister in the conduct
of religious worship or the ministration
of sacerdotal functions is in the exercise of
the ministry. The following example illus-
trates this rule:

Example: M, a duly ordained minister, is en-
gaged by N University to teach history and mathe-
matics. M performs no other service for N al-
though from time to time M performs marriages
and conducts funerals for relatives and friends.
N University is neither a religious organization
nor operated as an integral agency of a religious
organization. M is not performing the service for
N-under an assignment or designation by M’s
ecclesiastical superiors, The service performed by
M for N University is not in the exercise of M's
ministry. However, service performed by M in per-
forming marriages and conducting funerals is in
the exercise of M's ministry.

Service performed by a duly ordained,
commissioned, or licensed minister of a
church as an employee of the United
States, or a State, territory, or possession
of the United States, or the District of
Columbia, or a foreign government, or a
political subdivision of any of the fore-
going, is not considered to be in the exer-
cise of the ministry for purposes of the tax
on self-employment income, even though
this service may involve the ministration
of sacerdotal functions or the conduct of
religious worship. For example, service
performed by a chaplain in the Armed
Forces of the United States is considered
to be performed by a commissioned officer
in this capacity and not by a minister in
the exercise of the ministry. Similarly,
service performed by a chaplain in a State
prison or State University is considered to
be performed by a civil servant of the State
and not by a minister in the exercise of the
ministry.

E. Time Limitation for Filing Application
for Exemption.—An application for ex-
emption must be filed with the Internal
Revenue Service by the later of the two
following dates: (1) the due date of your
tax return (including extensions) for the
second tax year in which you have net
earnings from self-employment of $400 or
more, any part of which was derived from
services as a minister, member of a reli-
gious order or Christian Science _practi-
tioner; or (2) the due date (including ex-
tensions) of your tax return for your second
tax year ending after 1967.

Example: Reverend Aker, ordained in 1965, had
net ministerial earnings of $400 or more in all
years after 1965 and had not filed a waiver certifi-
cate electing social security coverage (Form 2031).
He should have filed an application for exemption
by April 15, 1970, or extended date.

Reverend Beeker, ordained in 1978, had ministe-
rial income of $400 or more in 1978 and in 1979.
He should have filed an application for exemption
not later than April 15, 1980, or extended date.

F. Effective Date of Exemption.—An ex-
emption from self-employment tax is effec-
tive for the first tax year ending after 1967,
and all succeeding tax years in which you
have net earnings from self-employment of
$400 or more, any part of which is derived
from services as a minister, member, or
practitioner. Thus, if you had qualified net
earnings of $400 or more in 1968 and not
again until 1979, a valid application for
exemption from self-employment tax filed
by April 15, 1980, would be effective for
1968 and all years thereafter. However,
contact an IRS office to see if you are en:
titled to file a claim for refund of self-em-
ployment taxes paid in prior tax years.

G. Where to File——Mail your application
to the Internal Revenue Service Center for
the place where you live.

New Jersey, New York City
and counties of Nassau,
Rockland, Suffolk, and
Westchester

New York (ail other counties),
Connecticut, Maine,
Massachusetts, New
Hampshire, Rhode Istand,
Vermont

Holtsville, NY 00501

Andover, MA 05501

Alabama, Florida, Georgia,
Mississippi, South Carolina

Michigan, Ohio

31101
45999

Atlanta, GA

Cincinnati, OH

Louisiana, New Mexico,
‘Arkansas, Kansas,
Oklahoma, Texas

Alaska, Arizona, Colorado,
Idaho, ‘Minnesota, Montana,
Nebraska, Nevada, North
Dakota, Oregon, South
Dakota, Utah, Washington,
Wyoming

Hlinois, lowa, Missoure,
Wisconsin
Califorma, Hawaii

Indiana, Kentucky, North
Carolina, Tennes
Virginia, West

Delaware, District of
Columbia, Maryland,
Pennsylvania

Austin, TX 73301

Ogden, UT 84201

Kansas City, MO 64999

Fresno, CA 93888

Memphis, TN 37501

Philadelphia, PA 19255

If you have no legal residence in the United
States then mail this form to the Internal Reve-
nue Service Center, Philadelphia, PA 19255.

H. Extensions of Time for Filing and
Noncalendar Year Taxpayers.—In general,
the filing dates stated do not apply if you
file your tax return for other than a calen-
dar year or you are granted an extension
of time to file your return. Contact the near-
est Internal Revenue Service office for ap-
plicable dates.

I. How to Indicate Exemption on Form
1040.—If your only income subject to self-
employment tax is from ministerial serv-
ices, and Copy C has been returned to you
approved by the Internal Revenue Service,
write “‘Exempt-Form 4361” on the self-em-
ployment line in Other Taxes section of
Form 1040. However, if you have other
income subject to self-employment tax, see
Schedule SE (Form 1040).

J. Revocation of Exemption.—You may
not revoke the exemption once it is re-
ceived,

Specific Instructions

Item 2.—Enter your social security
number as it appears on your social secu-
rity card. If you have no number, file ap-
plication Form SS-5 with the local office
of the Social Security Administration. If
you do not receive your card in time, file
Form 4361 and enter ‘‘Applied for” in the
space provided for the number.

Item 4.—Enter the date you were duly
ordained, commissioned, or-licensed as a
minister of a church, or date you became
a member of a religious order, or date you
commenced practice as a Christian Science
practitioner. No application for exemption
should be filed prior to this date. A copy of
the certificate (or a letter from the govern-
ing body of your church if you did not re-
ceive a certificate) establishing your status
as a duly ordained, commissioned, or a li-
censed minister, or a member of a religious
order, or Christian Science practitioner,
must be attached to the form.

Item 5.—If you are a minister or a mem-
ber of a religious order, enter the legal
name, address, and employer identification
number of the church denomination that
ordained, commissioned, or licensed you
or the order of which you are now a mem-
ber. The employer identification number
should be obtained from the ordaining,
licensing, or commissioning body or reli-
gious order.


Application for Exemption from Self-Employment
Tax for Use by Ministers, Members of Religious
Internal Revenue Service” Orders and Christian Science Practitioners
Documentation required by Specific Instruction Item 4 MUST be attached to this form. Before filing this form see General Instructions.
2 Social security number

rom 4361

(Rev. September 1981)

OMB No. 1545-0168
Expires 8/31/84

1 Name

Address

City or town, State and ZIP code

Please type or print

3 Check ONLY ONE box: [-] Christian Science practitioner
[LJ Member of religious order not under a vow of poverty

(J Ordained minister, priest, rabbi
[FJ Commissioned or licensed minister (see Item 7)

4 Date ordained, licensed, etc.

5 Legal name of ordaining, licensing, or commissioning body or religious order Employer identification number

Address

City or town, State and ZIP code

6 Enter the first two years after the date entered in Item 4, above, in which you had net earnings from self-employ-
ment of $400 or more, some part of which was from services as a minister, priest, rabbi, etc.; or as a member of
a religious order; or as a Christian Science practitioner . . > 19 19
Caution: Form 4361 is not proof of any of the following: @ the right to an exemption from “Federal income tax withholding and
social security tax; (b) the right to a parsonage allowance exclusion (section 107 of the Internal Revenue Code); or (c)
assignment by your religious superiors to a particular job.

7 If you are applying for the exemption as a licensed or commissioned minister, and your denomination provides for the ordination of ministers,
please indicate to what extent your ecclesiastical powers differ from those of an ordained minister of your denomination and attach a copy of your
denomination’s by-laws relating to the powers of ordained, and commissioned or licensed ministers.

8 | certify that, because of my religious principles, | am conscientiously opposed to the acceptance (with respect to services performed by me as a

minister, member, or practitioner) of the benefits of any public insurance that makes payments in the event of death, disability, old-age, or
retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system estab-

lished by the Social Security Act).

| certify that 1 did not file an effective waiver certificate (Form 2031) electing social security coverage on earnings as a minister, member, or

practitioner.

1 hereby request an exemption from payment of self-employment tax with respect to ‘my earnings from services as a minister, member, or

practitioner, pursuant to the provisions of section 1402(e) of the Internal Revenue Code.

| understand that the exemption, if granted, will

apply only to such earnings. Under penalties of perjury, | declare that this application has been examined by me and to the best of my knowiedge

and belief it is true and correct.

Signature >

Note: The exemption is granted only if the application is approved by Internal Revenue Service,

For Internal Revenue Service Use
(1 Approved for exemption from self-employment tax (see Caution above)
(1 Disapproved for exemption from self-employment tax

By ...

@irector’s signature)

(ate)

Date >
ind Copy C is returned to you marked “approved.”
COPY A
To be retained

by Internal
Revenue Service

General Instructions
This form must be filed in triplicate with the
Internal Revenue Service.

Paperwork Reduction Act Notice.—The
Paperwork Reduction Act of 1980 says
we must tell you why we are collecting
this information, how we will use it, and
whether you have to give it to us. We ask
for the information to carry out the Internal
Revenue laws of the United States. We need
it to ensure that you are complying with
these laws and to allow us to figure and col-
lect the right amount of tax. You are re-
quired to give us this information.

If you are a member of a religious order who
has taken a vow of poverty, do not file this form
because you are automatically exempt from the
payment of self-employment tax for amounts
earned for services performed for your church
or an integral agency thereof. However, members
of a religious order who are under a vow of pov-
erty and are paid to perform services for an

organization other than the church or an integral
agency of it are treated as regular employees of
this organization for Federal employment tax
purposes (Federal income tax withholding, social
security and Federal unemployment tax). The
automatic exemption from self-employment tax
does not apply to amounts earned during such
employment.

A. Purpose of This Form.—This form
should be used to request exemption under
the Self-Employment Contributions Act for
services performed by a minister, member
of a religious order, or Christian Science
practitioner.

B. Who May File for Exemption.—Any
duly ordained, commissioned, or licensed
minister of a church, member of a religious
order (who has not taken the vow of
poverty), or Christian Science practitioner
may file for exemption from self-employ-
ment tax. To be eligible for the exemption,
the applicant must establish that the or-

daining, commissioning, or licensing body
(or religious order) is a church that is ex-
empt from Federal income tax under sec-
tion 501(a) of the Internal Revenue Code
as a religious organization described in
section 501(c)(3), and must also establish
that the church (or convention or associa-
tion of churches) is one described in sec-
tion 170(b)(1)(A)(i). The request must be
based on a conscientious opposition, be-
cause of the applicant's religious princi-
ples, to accepting (for services performed
as a minister, member, or practitioner)
public insurance (including social security
benefits) that makes payments in the event
of death, disability, old-age, or retirement
or makes payments toward the cost of, or
provides services for, medical care. How-
ever, if the minister, member, or practi-
tioner has previously filed an effective
waiver certificate Form 2031, an applica-
tion for exemption may NOT now be filed.

Commissioned or licensed ministers of
a church or church denomination that pro-
(Continued on back)



vides for ordination of ministers may file
an application for exemption if they are
invested with the authority to perform sub-
stantially all of the religious duties of their
church or church denomination.

For more information, see Publication
517, Social Security for Members of the
Clergy and Religious Workers.

C. Earnings to Which This Exemption
Applies.—An exemption that is effective
for a duly ordained, commissioned, or li-
censed minister of a church applies only to
service performed in the exercise of the
ministry.

Service performed by a minister in the
exercise of the ministry includes the min-
istration of sacerdotal functions, the con-
duct of religious worship, and the control,
conduct, and maintenance of religious or-
ganizations (including the religious boards,
societies, and other integral agencies of
such organizations), under the authority of
a religious body constituting a church or
church denomination. The following rules
apply in determining whether services per-
formed by a minister are performed in the
exercise of the ministry.

If a minister is performing service in
the conduct of religious worship or the
ministration of sacerdotal functions, this
service is in the exercise of the ministry
whether or not it is performed for a reli-
gious organization.

If a minister is performing service for an
organization that operates as an integral
agency of a religious organization under
the authority of a religious body constitut-
ing a church or church denomination, all
service performed by the minister in the
conduct of religious worship, in the minis-
tration of sacerdotal functions, or in the
control, conduct, and maintenance of such
organization is in the exercise of the min-
istry. The following example illustrates
this rule:

Example: M, a duly ordained minister, is en-
gaged by the N Religious Board to serve as director
of one of its departments. M performs no other
service. The N Religious Board is an integral
agency of 0, a religious organization operating
under the authority of a religious body constituting
a church denomination. M is performing service in
the exercise of M's ministry.

If a minister, under an assignment or
designation by a religious body constitut-
ing the minister's church, performs service
for an organization that is neither a reli-
gious organization nor operated as an inte-
gral agency of a religious organization, all
service performed by the minister, even
though this service may not involve the
conduct of religious worship or the min-
istration of sacerdotal functions, is in the
exercise of the ministry. Ordinarily, the
services of a minister are not assigned or
designated services if any of the following
circumstances are present: (1) the organi-
zation for which the minister performs the
services did not arrange with the minister’s
church for the minister's services; (2) the
minister is performing services for the or-
ganization that other employees of the or-
ganization who have not been so desig-
nated are performing; or (3) the minister
performed the same services before and
after the designation.

D. Earnings to Which This Exemption
Does Not Apply.—An exemption that is ef-
fective for a duly ordained, commissioned,
or licensed minister of a church does not
apply to service performed that is not in
the exercise of the ministry.

If a minister is performing service for an
organization that is neither a religious
organization nor operated as an integral

agency of a religious organization and the
service is not performed under an assign-
ment or designation by the minister's ec-
clesiastical superiors, then only the service
performed by the minister in the conduct
of religious worship or the ministration
of sacerdotal functions is in the exercise of
the ministry. The following example illus-
trates this rule:

Example: M, a duly ordained minister, is en-
gaged by N University to teach history and mathe-
matics. M performs no other service for N al-
though from time to time M performs marriages
and conducts funerals for relatives and friends.
N University is neither a religious organization
nor operated as an integral agency of a religious
organization. M is not performing the service for
N-under an assignment or designation by M's
ecclesiastical superiors. The service performed by
M for N University is not in the exercise of M's
ministry. However, service performed by M in per-
forming marriages and conducting funerals is in
the exercise of M’s ministry.

Service performed by a duly ordained,
commissioned, or licensed minister of a
church as an employee of the United
States, or a State, territory, or possession
of the United States, or the District of
Columbia, or a foreign government, or a
political subdivision of any of the fore-
going, is not considered to be in the exer-
cise of the ministry for purposes of the tax
on self-employment income, even though
this service may involve the ministration
of sacerdotal functions or the conduct of
religious worship. For example, service
performed by a chaplain in the Armed
Forces of the United States is considered
to be performed by a commissioned officer
in this capacity and not by a minister in
the exercise of the ministry. Similarly,
service performed by a chaplain in a State
prison or State University is considered to
be performed by a civil servant of the State
and not by a minister in the exercise of the
ministry.

E. Time Limitation for Filing Application
for Exemption.—An application for ex-
emption must be filed with the Internal
Revenue Service by the later of the two
following dates: (1) the due date of your
tax return (including extensions) for the
second tax year in which you have net
earnings from self-employment of $400 or
more, any part of which was derived from
services as a minister, member of a reli-
gious order or Christian Science practi-
tioner; or (2) the due date (including ex-
tensions) of your tax return for your second
tax year ending after 1967.

Example: Reverend Aker, ordained in 1965, had
net ministerial earnings of $400 or more in all
years after 1965 and had not filed a waiver certifi-
cate electing social security coverage (Form 2031).
He should have filed an application for exemption
by April 15, 1970, or extended date.

Reverend Beeker, ordained in 1978, had ministe-
rial income of $400 or more in 1978 and in 1979.
He should have filed an application for exemption
not later than April 15, 1980, or extended date.

F. Effective Date of Exemption.—An ex-
emption from self-employment tax is effec-
tive for the first tax year ending after 1967,
and all succeeding tax years in which you
have net earnings from self-employment of
$400 or more, any part of which is derived
from services as a minister, member, or
practitioner. Thus, if you had qualified net
earnings of $400 or more in 1968 and not
again until 1979, a valid application for
exemption from self-employment tax filed
by April 15, 1980, would be effective for
1968 and all years thereafter. However,
contact an IRS office to see if you are en-
titled to file a claim for refund of self-em-
ployment taxes paid in prior tax years.

G. Where to File——Mail your application
to the Internal Revenue Service Center for
the place where you live.

New Jersey, New York City
and counties of Nassau,
Rockland, Suffolk, and
Westchester

New York (ail other counties),
Connecticut, Maine,
Massachusetts, New
Hampshire, Rhode Island,
Vermont

‘Alabama, Florida, Georgia,
Mississippi, South Carolina
Michigan, Ohio

Louisiana, New Mexico,

Arkansas, Kansas,
Oklahoma, Texas.

‘Alaska, Arizona, Colorado,
Idaho,’ Minnesota, Montana,
Nebraska, Nevada, North
Dakota, Oregon, South
Dakota, Utah, Washington,
Wyoming

Mlinois, lowa, Missouri,
Wisconsin
California, Hawaii

Indiana, Kentucky, North
Carolina, Tennessee,
Virginia, West Virginia

District of
Maryland,
Pennsylvania

If you have no legal residence in the United
States then mail this form to the Internal Reve-
nue Service Center, Philadelphia, PA 19255.

H. Extensions of Time for Filing and
Noncalendar Year Taxpayers.—In general,
the filing dates stated do not apply if you
file your tax return for other than a calen-
dar year or you are granted an extension
of time to file your return. Contact the near-
est Internal Revenue Service office for ap-
plicable dates.

|. How to Indicate Exemption on Form
1040.—/f your only income subject to self-
employment tax is from ministerial serv-
ices, and Copy C has been returned to you
approved by the Internal Revenue Service,
write “Exempt-Form 4361” on the self-em-
ployment line in Other Taxes section of
Form 1040. However, if you have other
income subject to self-employment tax, see
Schedule SE (Form 1040).

J. Revocation of Exemption.—You may
not revoke the exemption once it is re-
ceived.

Specific Instructions

Item 2.—Enter your social security
number as it appears on your social secu-
rity card. If you have no number, file ap-
plication Form SS-5 with the local office
of the Social Security Administration. If
you do not receive your card in time, file
Form 4361 and enter “Applied for” in the
space provided for the number.

Item 4.—Enter the date you were duly
ordained, commissioned, or licensed as a
minister of a church, or date you became
a member of a religious order, or date you
commenced practice as a Christian Science
practitioner. No application for exemption
should be filed prior to this date. A copy of
the certificate (or a letter from the govern-
ing body of your church if you did not re-
ceive a certificate) establishing your status
as a duly ordained, commissioned, or a li-
censed minister, or a member of a religious
order, or Christian Science practitioner,
must be attached to the form.

Item 5.—If you are a minister or a mem-
ber of a religious order, enter the legal
name, address, and employer identification
number of the church denomination that
ordained, commissioned, or licensed you
or the order of which you are now a mem-
ber. The employer identification number
should be obtained from the ordaining,
licensing, or commissioning body or reli-
gious order.

Holtsville, NY 00501

‘Andover, MA 05501

Atlanta, GA 31101

45999

Cincinnati, OH

‘Austin, TX 73301

Ogden, UT 84201

64999
93888

Kansas City, MO

Fresno, CA

Memphis, TN 37501

Philadelphia, PA 19255



vom 4361

(Rev. September 1981)

Department of the Treasury
Internal Revenue Service

Application for Exemption from Self-Employment
Tax for Use by Ministers, Members of Religious
Orders and Christian Science Prac!

OMB No. 1545-0168
Expires 8/31/84

ioners

Documentation required by Specific Instruction Item 4 MUST be attached to this form. Before filing this form see General Instructions.

1 Name

2 Social security number

Address

City or town, State and ZIP code

Please type or print

3 Check ONLY ONE box:

[LJ Christian Science practitioner
[] Member of religious order not under a vow of poverty

(CJ Ordained minister, priest, rabbi

[[] Commissioned or licensed minister (see Item 7)

4 Date ordained, licensed, etc.

5 Legal name of ordaining, licensing, or commissioning body or religious order

Employer identification number

Address

City or town, State and ZIP code

6 Enter the first two years after the date entered in Item 4, above, in which you had net earnings from self-employ-
a minister, priest, rabbi, etc.; or as a member

ment of $400 or more, some part

of which was from services as
a religious order; or as a Christian Science practitioner . . -

19 19

Caution: Form 4361 is not proof of any of the following: (a) the right to an exemption from Federal income tax withholding and
social security tax; (b) the right to a parsonage allowance exclusion (section 107 of the Internal Revenue Code); or (c)
assignment by your religious superiors to a particular job.

7 If you are applying for the exemption as a licensed or commissioned minister, and your denomination provides for the ordination of ministers,
please indicate to what extent your ecclesiastical powers differ from those of an ordained minister of your denomination and attach a copy of your
denomination’s by-laws relating to the powers of ordained, and commissioned or licensed ministers.

8 | certify that, because of my religious principles, | am conscientiously opposed to the acceptance (with respect to services performed by me as a
minister, member, or practitioner) of the benefits of any public insurance that makes payments in the event of death, disability, old-age, or
retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system estab-

lished by the Social Security Act).

| certify that | did not file an effective waiver certificate (Form 2031) electing social security coverage on earnings as a minister, member, or

practitioner.

| hereby request an exemption from payment of self-employment tax with respect to my earnings from services as a minister, member, or

practitioner, pursuant to the provisions of section 1402(e) of the Internal Revenue Code. | understand that the exemption,

if granted, will

apply only to such earnings. Under penalties of perjury, | declare that this application has been examined by me and to the best of my knowledge

and belief it is true and correct.

Signature >

Date >

Note: The exemption is granted only if the application is approved by Internal Revenue Service, and Copy C is returned to you marked “‘approved.”

For Internal Revenue Service Use
(2 Approved for exemption from self-employment tax (see Caution above)
(1 Disapproved for exemption from self-employment tax

By ..

(ate)

COPY B
To be forwarded
to Social Security
Administration

General Instructions

This form must be filed in triplicate with the

Internal Revenue Service.
Paperwork Reduction Act Notice.—The
Paperwork Reduction Act of 1980 says
we must tell you why we are collecting
this information, how we will use it, and
whether you have to give it to us. We ask
for the information to carry out the Internal
Revenue laws of the United States. We need
it to ensure that you are complying with
these laws and to allow us to figure and col-
lect the right amount of tax. You are re-
quired to give us this information.

If you are a member of a religious order who
has taken a vow of poverty, do not file this form
because you are automatically exempt from the
payment of self-employment tax for amounts
earned for services performed for your church
or an integral agency thereof. However, members
of a religious order who are under a vow of pov-
erty and are paid to perform services for an

organization other than the church or an integral
agency of it are treated as regular employees of
this organization for Federal employment tax
purposes (Federal income tax withholding, social
security and Federal unemployment tax). The
automatic exemption from self-employment tax
does not apply to amounts earned during such
employment.

A. Purpose of This Form.—This form
should be used to request exemption under
the Self-Employment Contributions Act for
services performed by a minister, member
of a religious order, or Christian Science
practitioner.

B. Who May File for Exemption.—Any
duly ordained, commissioned, or licensed
minister of a church, member of a religious
order (who has not taken the vow of
poverty), or Christian Science practitioner
may file for exemption from self-employ-
ment tax. To be eligible for the exemption,
the applicant must establish that the or-

daining, commissioning, or licensing body
(or religious order) is a church that is.ex-
empt from Federal income tax under sec-
tion 501(a) of the Internal Revenue Code
as a religious organization described in
section 501(c)(3), and must also establish
that the church (or convention or associa-
tion of churches) is one described in sec-
tion 170(b)(1)(A)(i). The request must be
based on a conscientious opposition, be-
cause of the applicant's religious princi-
ples, to accepting (for services performed
as a minister, member, or practitioner)
public insurance (including social security
benefits) that makes payments in the event
of death, disability, old-age, or retirement
or makes payments toward the cost of, or
provides services for, medical care. How-
ever, if the minister, member, or practi-
tioner has previously filed an effective
waiver certificate Form 2031, an applica-
tion for exemption may NOT now be filed.

Commissioned or licensed ministers of
a church or church denomination that pro-
(Continued on back)