OMB No. 1545-0168

Expires 6-30-94 Application for Exemption From Self-Employment

Tax for Use by Ministers, Members of Religious

Orders and Christian Science Practitioners

Form 4361

(Rev. June 1991) File Original

and Two Copies Department of the Treasury

Internal Revenue Service

File original and two copies and attach supporting documents. This exemption is granted only if the IRS returns a copy to you marked “approved.”

1 Name of taxpayer shown on Form 1040 Social security number

Number and street (including apt. no.) Telephone number (optional)

( )

City or town, state, and ZIP code

Please type or print

Date ordained, licensed, etc.

(Attach supporting

document. See instructions.)

3 2

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

/ /

Number, street, and room or suite no. Employer identification number

City or town, state, and ZIP code

Enter the first 2 years, after the date shown on line 3, that you had net self-employment earnings of $400 or more, any of

which came from services as a minister, priest, rabbi, etc.; member of a religious order; or Christian Science practitioner ©

5

19 19

If you apply for the exemption as a licensed or commissioned minister, and your denomination also ordains ministers, please indicate how your ecclesiastical

powers differ from those of an ordained minister of your denomination. Attach a copy of your denomination’s by-laws relating to the powers of ordained,

commissioned, or licensed ministers.

6

7 I certify that I am conscientiously opposed to, or because of my religious principles I am opposed to, the acceptance (for services I perform as a minister,

member of a religious order not under a vow of poverty, or a Christian Science practitioner) of any public insurance that makes payments in the event of death,

disability, old age, or retirement; or that makes payments toward the cost of, or provides services for, medical care. (Public insurance includes insurance

systems established by the Social Security Act.)

I certify that as a duly ordained, commissioned, or licensed minister of a church or a member of a religious order not under a vow of poverty, I have informed the

ordaining, commissioning, or licensing body of my church or order that I am conscientiously opposed to, or because of religious principles, I am opposed to the

acceptance (for services I perform as a minister or as a member of a religious order) of any public insurance that makes payments in the event of death,

disability, old age, or retirement; or that makes payments toward the cost of, or provides services for, medical care, including the benefits of any insurance

system established by the Social Security Act.

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

under a vow of poverty, or a Christian Science practitioner.

I request to be exempted from paying self-employment tax on my earnings from services as a minister, member of a religious order not under a vow of poverty,

or a Christian Science practitioner, under section 1402(e) of the Internal Revenue Code. I understand that the exemption, if granted, will apply only to these

earnings. Under penalties of perjury, I declare that I have examined this application and to the best of my knowledge and belief, it is true and correct.

Signature © Date ©

Caution: Form 4361 is not proof of the right to an exemption from Federal income tax withholding or social security tax, the right to a parsonage

allowance exclusion (section 107), assignment by your religious superiors to a particular job, or the exemption or church status of the ordaining, licensing,

commissioning body, or religious order.

For Internal Revenue Service Use

Approved for exemption from self-employment tax on ministerial earnings 

Disapproved for exemption from self-employment tax on ministerial earnings

By

(Director’s signature) (Date)

General Instructions

(Section references are to the Internal

Revenue Code.)

Paperwork Reduction Act Notice.—We ask

for the information on this form to carry out

the Internal Revenue laws of the United

States. You are required to give us the

information. We need it to ensure that you are

complying with these laws and to allow us to

figure and collect the right amount of tax. Purpose of Form.—File Form 4361 to apply

for an exemption from self-employment tax if

you are:

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time

is:

Recordkeeping, 7 minutes; Learning about

the law or the form, 19 minutes; Preparing

the form, 16 minutes; Copying, assembling,

and sending the form to IRS, 17 minutes.

suggestions for making this form more

simple, we would be happy to hear from you.

You can write to both the Internal Revenue

Service, Washington, DC 20224, Attention:

IRS Reports Clearance Officer, T:FP; and the

Office of Management and Budget,

Paperwork Reduction Project (1545-0168),

Washington, DC 20503. DO NOT send the

form to either of these offices. Instead, see

Where To File on page 2.

(continued on page 2)

Form 4361 (Rev. 6-91)

Check ONE box: Christian Science practitioner Ordained minister, priest, rabbi

Member of religious order not under a vow of poverty Commissioned or licensed minister (see line 6)

● An ordained, commissioned, or licensed

minister of a church;

● A member of a religious order who has not

taken a vow of poverty;

● A Christian Science practitioner; or

ordains ministers, if you have authority to

perform substantially all religious duties of

your church or denomination.

Cat. No. 41586H

This application must be based on your

religious or conscientious opposition to the

acceptance (for services performed as a

minister, member of a religious order, or

Christian Science practitioner) of any public

insurance that makes payments for death,

disability, old age, or retirement; or that

makes payments for the cost of, or provides

services for, medical care, including any

insurance benefits established by the Social

Security Act.

If you are a duly ordained, commissioned,

or licensed minister of a church or a member

of a religious order not under a vow of

poverty, prior to filing this form you must

inform the ordaining, commissioning, or

If you have comments concerning the

accuracy of these time estimates or

● A commissioned or licensed minister of a

church or church denomination that
Form 4361 (Rev. 6-91) Page 2

Earnings To Which Exemption Applies.—

Only earnings from ministerial services are

exempt from self-employment tax.

Specific Instructions

Conducting religious worship services or

ministering sacerdotal functions are ministerial

services whether or not performed for a

religious organization.

Line 1—Social Security Number.—Enter

your social security number. If you do not

have one, file Form SS-5, Application for a

Social Security Card, with your local Social

Security Administration office. If you do not

receive your card in time, file Form 4361 and

enter “applied for” in the space for your

social security number.

When To File.—File Form 4361 by the date

your tax return is due, including extensions,

for the second tax year in which you had at

least $400 of net earnings from selfemployment, any of which came from

services performed as a minister, member of

a religious order, or Christian Science

practitioner.

Ministerial services also include those

performed under the authority of a church or

church denomination. Examples are

controlling, conducting, and maintaining

religious organizations, including religious

boards, societies, and other agencies integral

to these organizations.

Where To File.—Mail the original and two

copies of this form to the Internal Revenue

Service Center for the place where you live.

If your church assigns or designates you to

perform services for an organization that is

neither a religious organization nor an integral

agency of a religious organization, you are

performing ministerial services, even though

they may not involve conducting religious

worship or ministering sacerdotal functions.

Your services are ordinarily not considered

assigned or designated by your church if any

of the following is true:

You must be able to show that the body

that ordained, commissioned, or licensed you,

or your religious order, is exempt from

Federal income tax under section 501(a) as a

religious organization described in section

501(c)(3). You must also be able to show that

the body is a church (or convention or

association of churches) described in section

170(b)(1)(A)(i). To assist the service center in

processing your application, you can attach a

copy of the exemption letter issued to the

organization by the IRS. If that is not

available, you can attach a letter signed by an

individual authorized to act for the

organization stating that the organization

meets both of the above requirements.

Use this address:

Ä

If you live in:

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Florida, Georgia,

South Carolina Atlanta, GA 39901

New Jersey, New York City and

counties of Nassau, Rockland,

Suffolk, and Westchester

Holtsville, NY 00501

Connecticut, Maine,

Massachusetts, New Hampshire,

New York (all other counties),

Rhode Island, Vermont

Line 3.—Enter the date you were ordained,

commissioned, or licensed as a minister of a

church; became a member of a religious

order; or began practice as a Christian

Science practitioner. Do not file Form 4361

before this date. Attach a copy of the

certificate (or, if you did not receive one, a

letter from the governing body of your church)

that establishes your status as an ordained,

commissioned, or licensed minister; a

member of a religious order; or a Christian

Science practitioner.

● The organization for which you perform

the services did not arrange with your

church for your services.

Andover, MA 05501

● You perform the same services for the

organization as other employees not

designated as you were.

Delaware, District of

Columbia, Maryland,

Pennsylvania, Virginia

Philadelphia, PA 19255

● You perform the same services before

and after the designation.

Illinois, Iowa, Minnesota,

Missouri, Wisconsin Kansas City, MO 64999

Earnings To Which Exemption Does Not

Apply.—Exemption from self-employment tax

does not apply to earnings from services that

are not ministerial.

Indiana, Kentucky, Michigan,

Ohio, West Virginia Cincinnati, OH 45999

Kansas, New Mexico,

Oklahoma, Texas Austin, TX 73301

Line 4.—If you are a minister or belong to a

religious order, enter the legal name, address,

and employer identification number of the

denomination that ordained, commissioned,

or licensed you, or the order to which you

belong. Get the employer identification

number from your church or order.

Alaska, Arizona, California (counties

of Alpine, Amador, Butte, Calaveras,

Colusa, Contra Costa, Del Norte, El

Dorado, Glenn, Humboldt, Lake,

Lassen, Marin, Mendocino, Modoc,

Napa, Nevada, Placer, Plumas,

Sacramento, San Joaquin, Shasta,

Sierra, Siskiyou, Solano, Sonoma,

Sutter, Tehama, Trinity, Yolo, and

Yuba), Colorado, Idaho, Montana,

Nebraska, Nevada, North Dakota,

Oregon, South Dakota, Utah,

Washington, Wyoming

Ogden, UT 84201

Effective Date of Exemption.—An exemption

from self-employment tax is effective for all

tax years ending after 1967 in which you

have net self-employment earnings of $400 or

more, if you derive any of it from ministerial

services. For example, if you had qualified net

earnings of $400 or more in 1968 and not

again until 1991, a valid Form 4361 filed by

April 15, 1992, would apply to 1968 and all

later years. Refer to Pub. 517 to see if you

are entitled to a refund of self-employment

tax paid in earlier years.

Earnings from the following entities are not

exempt even if religious services are

conducted or sacerdotal functions are

ministered: the United States; a state,

territory, or possession of the U.S.; the

District of Columbia; a foreign government; or

a subdivision of any of these bodies. For

example, chaplains in the U.S. Armed Forces

are considered commissioned officers, not

ministers. Similarly, chaplains in state prisons

or universities are considered civil servants.

California (all other counties),

Hawaii Fresno, CA 93888

Alabama, Arkansas, Louisiana,

Mississippi, North Carolina,

Tennessee

Memphis, TN 37501

Commissioner of

Revenue and Taxation

855 West Marine Drive

Agana, GU 96910

Guam

Northern Mariana Islands

(Commonwealth of the) Philadelphia, PA 19255

Puerto Rico (or if excluding

income under section 933)

Virgin Islands:

Nonpermanent residents

Philadelphia, PA 19255

V.I. Bureau of Internal

Revenue 

Lockharts Garden 

No. 1A 

Charlotte Amalie 

St. Thomas, VI 00802

Virgin Islands:

Permanent residents

Indicating Exemption on Form 1040.—If the

IRS returned your application marked

“approved” and your only self-employment

income was from ministerial services, write

“Exempt—Form 4361” on the selfemployment line in the Other Taxes section

of Form 1040. If you had other

self-employment income, see Schedule SE

(Form 1040).

Foreign country:

U.S. citizens and those filing

Form 2555 or Form 4563

Philadelphia, PA 19255

All A.P.O. or

F.P.O. addresses Philadelphia, PA 19255

Approval of Application.— Before your

application can be approved, the IRS must

verify that you are aware of the grounds for

exemption and that you want the exemption

on that basis. When your completed Form

4361 is received, the IRS will mail you a

statement that describes the grounds for

receiving an exemption under section 1402(e).

You must certify that you have read the

statement and seek exemption on the

grounds listed on the statement. The

certification must be made by signing a copy

of the statement under penalties of perjury

and mailing it to the IRS service center that

issued it, not later than 90 days after the date

the statement was mailed to you. If it is not

mailed by that time, your exemption will not

be effective until the date the signed copy is

received by the service center.

Do not file Form 4361 if:

● You ever filed a waiver certificate (Form

2031); or

● You belong to a religious order and took

a vow of poverty. You are automatically

exempt from self-employment tax on

earnings for services you perform for your

church or its agencies. No tax exemption

applies to earnings for services you

perform for any other organization.

Additional Information.—For more

information, get Pub. 517, Social Security for

Members of the Clergy and Religious

Workers.

licensing body of your church or order that

you are opposed to the acceptance of public

insurance benefits based on ministerial

service on religious or conscientious grounds.

If your application is approved, a copy of

Form 4361 will be returned to you marked

“approved.” Once the exemption is approved,

you cannot revoke it.

American Samoa Philadelphia, PA 19255