rom SE68

(Rev, Oct. 1981)

Department of the Treasury
Internal Reveriue Service

Election/Revocation of Election by an Eligible
Section 501(c)(3) Organization to Make

Expenditures to Influence Legislation
(Under Section 501(h) of the Internal Revenue Code)

For IRS
Use Only >

Name of organization

Employer identification number

‘Address (number and street)

City or town, State, and ZIP code

1 Election.—As an eligible organization we hereby elect to have the provisions of subsection 501(h) of the Code, relating

to expenditures to influence legislation, apply to our tax year ending

queni tax years until revoked.

... and all subse-

(Month, day, and year)

Note: This election must be signed and postmarked within the first taxable year to which it applies.

2 Revocation.—As an eligible organization we hereby revoke our election to have the provisions of subsection 501(h) of

the Code, relating to expenditures to influence legislation, apply to our tax year ending ..

(Month, day, and year)

Note: This revocation must be signed and postmarked before the first day of the tax year to which it applies.

Under penalties of perjury, | declare that | am authorized to make this (check applicable box) B ("] election/[-] revocation on behalf

of the above named organization.

~Gignature of off

ities

Instructions
(References are to the Internal Revenue Code)

Section 501(c)(3) provides that an orga-
nization exempt under that section will lose
its tax-exempt status and its qualification to
receive deductible charitable contributions
if a substantial part of its activities are
carried on to influence legislation. Section
501(h), however, permits certain eligible
501(c)(3) organizations to elect to make
limited expenditures to influence legislation.
The election applies only to tax years begin-
ning after December 31, 1976. An organiza-
tion making the election will, however, be
subject to an excise tax under section 4911
if it spends more than the amounts per-
mitted by that section. Furthermore, the
organization may lose its exempt status if its
lobbying expenditures exceed the permitted
amounts by more than 50% over a 4-year
period. For any tax year in which an election
under section 501(h) is in effect, an electing
organization must report the actual and per-
mitted amounts of its lobbying expenditures
and grass roots expenditures (as defined in
section 4911(c)) on its annual return re-
quired under section 6033, See Schedule A
(Form 990). Each electing member of an
affiliated group must report these amounts
for both itself and the affiliated group as a
whole.

To make or revoke the election, enter the
ending date of the tax year to which the elec-
tion or revocation applies in item 1 or 2, as
applicable, and sign (give title) and date the
form in the spaces provided.

Eligible Organizations—A _501(c)(3) or-
ganization is permitted to make the election
if it is not a disqualified organization (see
below) and is described in:

(a) section 170(b)(1)(A)(ii) (relating to
educaticnal institutions),
(b) section 170(b)(1)(A)(iii) (relating to
hospitals and medical research or-
ganizations),
section 170(b)(1)(A)(iv) (relating to
organizations supporting government
sschoo's),
section 170(b)(1)(A)(vi) (relating to
organizations publicly supported by
charitable contributions),
section 509(a)(2) (relating to organi-
zations publicly supported by admis-
sions, sales, etc.), or
section 509(a)(3) (relating to organi-
zations supporting certain types of
public charities other than those sec-
tion 509(a)(3)_ organizations that
support section 501(c) (4), (5), or (6)
organizations).
Disqualified Organizations.—The following
types of organizations are not permitted to
make the election:
(a) section 170(b)(1)(A)(i) organizations
(relating to churches),

(b) an integrated auxiliary of a church, or
a convention or association of
churches, or

(c) a member of an affiliated group of or-

ganizations if one or more members
of such group is described in (a) or
(b) of this paragraph.

Affiliated Organizations. —Organizations
are members of an affiliated group of or-
ganizations only if—(1) the governing
strument of one such organization requires
to be bound by the decisions of the other or-
ganization on legislative issues, or (2) the
governing board of one such organization
includes persons who (i) are specifically des-

(c

(C)

(e

(f

ignated representatives of another such or-
ganization or are members of the governing
board, officers, or paid executive staff mem-
bers of such other organization, and (ii) by
aggregating their votes have sufficient vot-
ing power to cause or prevent action on leg-
islative issues by the first such organization.

For details, see section 4911 and section

Note: A private foundation (including a
private operating foundation) is not an eli-
gible organization.

Where to File.—
Send election/

to

If principal office

of the organization
Is located in:

jicut, New Hi shire,
Malnes Mavaachusetts; ‘Andover, MA 05501
Rhode Island, or Vermont
‘Riabama, Florida, Georgia,
Mississippl, North Caroline, Atlanta, GA 31101
South Carolina, or Tennessee
Rent Weicar Austin, TK 73301
Kentucky, Michigan, 7
Aentuchy, Michigan Cincinnati, OH 45999
Fresno, CA 93888
Holtsville, NY 00501
Ai 3, lowa, Missouri, "
or Nebiaske Kansas City, MO 64999
fasta, dsho, Minnesot
tana,
Oregon, ‘South Dakota, Ogden, UT 84201
Washington, of Wisconsin
Delaware,
Philadelphia, PA 19255

# U.S, Government Printing Office: 1983—421-108/234

Form 5768 (Rev. 10-81)