Application for Exemption From Self-Employment Tax OMB No. 1545-0168

for Use by Ministers, Members of Religious Orders

and Christian Science Practitioners

Form 4361

(Rev. December 1999) 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 applying for exemption (as 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

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 bylaws 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 of the Internal Revenue Code), assignment by your religious superiors to a particular job, or the exemption or church

status of the ordaining, licensing, or 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.

Purpose of form. File Form 4361 to apply for an

exemption from self-employment tax if you are:

(continued on page 2)

Form 4361 (Rev. 12-99)

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

Cat. No. 41586H

● A commissioned or licensed minister of a

church or church denomination that ordains

ministers, if you have authority to perform

substantially all religious duties of your church or

denomination.

When to file. File Form 4361 by the due date,

including extensions, of your tax return for the

2nd tax year in which you had at least $400 of

net earnings from self-employment, any of which

came from services performed as a minister,

member of a religious order, or Christian Science

practitioner.

Do not file Form 4361 if:

● You ever filed a waiver certificate (Form 2031);

or

Additional information. See Pub. 517, Social

Security and Other Information for Members of

If you are a duly ordained, commissioned, or the Clergy and Religious Workers.

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 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.

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 not under a

vow of poverty, 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.

● You belong to a religious order and took a

vow of poverty. You are automatically exempt

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 receive any of it from ministerial services.

For Privacy Act and Paperwork Reduction Act Notice, See page 2

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.
Form 4361 (Rev. 12-99) Page 2

Exempt earnings. 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.

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.

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:



If you live in:



Florida, Georgia,

South Carolina Atlanta, GA 39901

New Jersey, New York (New York

City and counties of Nassau,

Rockland, Suffolk, and

Westchester)

Holtsville, NY 00501

New York (all other counties),

Connecticut, Maine,

Massachusetts, New Hampshire,

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

Nonexempt earnings. 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

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

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 United States; 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

Department of Revenue

and Taxation

Government of Guam

P.O. Box 23607

GMF, GU 96921

Guam:

Permanent residents

Guam:

Nonpermanent residents

Puerto Rico (or if excluding

income under section 933)

Virgin Islands:

Nonpermanent residents

Philadelphia, PA 19255

V.I. Bureau of Internal

Revenue 

9601 Estate Thomas

Charlotte Amalie 

St. Thomas, VI 00802

Virgin Islands:

Permanent residents

Indicating exemption on Form 1040. If the IRS

returns your application marked “approved” and

your only self-employment income was from

ministerial services, write “Exempt—Form 4361”

on the self-employment tax line in the Other

Taxes section of Form 1040. If you had other

self-employment income, see Schedule SE

(Form 1040).

Foreign country (or if a

dual-status alien):

U.S. citizens and those filing

Form 2555, 2555-EZ, or 4563

Philadelphia, PA 19255

All A.P.O. and

F.P.O. addresses Philadelphia, PA 19255

If your application is approved, a copy of

Form 4361 will be returned to you marked

“approved.” Keep this copy of Form 4361 for

your permanent records. Once the exemption is

approved, you cannot revoke it after the due

date (including extensions) of your Federal

income tax return for your second tax year

beginning after 1999.

American Samoa

Philadelphia, PA 19255 The Commonwealth of the

Northern Mariana Islands

Philadelphia, PA 19255

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.

Privacy Act and Paperwork Reduction Act

Notice. The Privacy Act of 1974 and the

Paperwork Reduction Act of 1980 require that

when we ask you for information we must first

tell you our legal right to ask for the information,

why we are asking for it, and how it will be used.

We must also tell you what could happen if we

do not receive it and whether your response is

voluntary, required to obtain a benefit, or

mandatory under the law.

The time needed to complete and file this

form will vary depending on individual

circumstances. The estimated average time is:

Recordkeeping, 7 min.; Learning about the law

or the form, 20 min.; Preparing the form, 16

min.; Copying, assembling, and sending the

form to the IRS, 17 min.

If you have comments concerning the

accuracy of these time estimates or suggestions

for making this form simpler, we would be happy

to hear from you. You can write to the Tax

Forms Committee, Western Area Distribution

Center, Rancho Cordova, CA 95743-0001. DO

NOT send the form to this address. Instead, see

Where to file on this page.

Our authority to ask for information is sections

6001, 6011, and 6012(a), which require you to

file a return or statement with us for any tax for

which you are liable. Your response is

mandatory under these sections. Section 6109

requires that you provide your social security

number on what you file. This is so we know

who you are, and can process your return and

other papers. You must fill in all parts of the tax

form that apply to you.

Generally, tax returns and return information

are confidential, as stated in section 6103.

However, section 6103 allows or requires the

Internal Revenue Service to disclose or give the

information shown on your tax return to others

as described in the Code. For example, we may

disclose your tax information to the Department

of Justice to enforce the tax laws, both civil and

criminal, to cities, states, the District of

Columbia, U.S. commonwealths or possessions,

and certain foreign governments to carry out

their tax laws.

Please keep this notice with your records. It

may help you if we ask you for other information.

If you have any questions about the rules for

filing and giving information, please call or visit

any Internal Revenue Service office.

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.

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

For example, if you had qualified net earnings of

$400 or more in 1968 and not again until 1999, a

valid Form 4361 filed by April 17, 2000, would

apply to 1968 and all later years. See Pub. 517

to find out if you are entitled to a refund of

self-employment tax paid in earlier years.

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.

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.