OMB No. 1545-0168

Expires 10-31-91

om 4361

(Rev. Nov. 1988)

Application for Exemption From Self-Employment
Tax for Use by Ministers, Members of Religious

en . sae File in
Departr it of the Treasur
Department of the Treasury Orders and Christian Science Practitioners Triplicate
File in triplicate and attach supporting items. This exemption is granted only if IRS returns a copy to you marked “approved.”
“e | 1 Name of taxpayer as shown on Form 1040 Social security number
3 | Address Telephone Number (optional)
E c)
8 City or town, state, and ZIP code
=
2 Check ONE box: [1] Christian Science practitioner [1 Ordained minister, priest, rabbi 3 Date ordained, caren
Member of religious order not under a vow of poverty] Commissioned or licensed minister (see line 6) See instructions.) ”
4 Legal name of ordaining, licensing, or commissioning body or religious order

Address Employer identification number

City or town, state, and ZIP code

5 Enter the first 2 years, after the date shown on line 3
any of which came from services as a: minister, pri
practitioner...)

that you ha
priest, rabbi, etc.

id net self-employment earnings of $400 or more,
; member of a religious order; or Christian Science

19 19

6 _ Ifyou apply for the exemption as a licensed or commissioned minister, and your denomination also ordains ministers, please indicate to what extent
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, and commissioned or licensed ministers.

certify that | am conscientiously opposed to, or because of my religious principles | am opposed to, the acceptance (for services | performed 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.)

| 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, | have informed the ordaining,
‘commissioning, or licensing body of my church or order that | am conscientiously opposed to, or because of religious principles, | am opposed to the acceptance (with respect
to services | 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.

poverty, or a Christian Science practitioner.

Science practitioner, under section

certify that ! 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

fequest 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
402(e) of the Internal Revenue Code. | understand that the exemption, if granted, will apply only to these earnings. Under penalties of

perjury, | declare that | 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

Oo Approved for exemption from self-employment tax on ministerial earnings (see Caution above)

Qo

(Director's Signature)

Disapproved for exemption from self-employment tax on ministerial earnings

General Instructions

(Section references are to the Internal
Revenue Code unless otherwise noted.)
Paperwork Reduction Act Notice.—We ask
for this information to carry out the Internal
Revenue laws of the United States. We need it
to ensure that taxpayers are complying with
these laws and to allow us to figure and collect
the right amount of tax. You are required to
give us this information.

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, 9 minutes; Preparing
the form, 11 minutes; Copying, assembling,
and sending the form to IRS, 17 minutes.

If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form more simple,
we would be happy to hear from you. You can
write to the Internal Revenue Service,

Washington, DC 20224, Attention: IRS
Reports Clearance Officer, TR:FP; or the
Office of Management and Budget,
Paperwork Reduction Project, Washington, DC
20503.

Purpose of Form.—File Form 4361 if you are
a minister, member of a religious order not
under a vow of poverty, or Christian Science
practitioner, and want an exemption from
self-employment tax on certain earnings. If
your application is approved, a copy will be
returned to you marked “approved.”

Who May Not Apply.—Do not file Form 4361
if:

° you ever filed a waiver certificate, Form

5; 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 an
integral agency of it.

Approval of Application.—Before your
application can be approved, IRS must verify

that you are aware of the grounds for
exemption and that yau want the exemption
‘on that basis. When your completed Form
4361 is received, 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
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. Once the exemption is approved, you
cannot revoke it.

Additional Information

If you need more information, get Pub. 517,
Social Security for Members of the Clergy and
Religious Workers.

(continued on page 2),

Form 4361. (Rev. 11-88)


Form 4361 (Rev. 11-88)

Page 2

When To —File Form 4361 by the date
your tax return is due, including extensions,
for the second tax year you have at least $400
in self-employment earnings, any of which
came from services performed as a minister,
member of a religious order, or Christian
Science practitioner. An extension to file your
tax return also applies to Form 4361.
Example: Reverend B, ordained in 1987, had
self-employment ministerial income over $400
in 1987 and 1988. He should file Form 4361
by April 17, 1989, or extended date.
Where To File.—Mail three copies of this
form to the Internal Revenue Service Center
for the place where you live. No street address
is needed.
Ifyou are located in: Use this address:
v v
Florida, Georgia,
South Carolina
New Jersey, New York City and
counties of Nassau, Rockland,
Suffolk, and Westchester
Connecticut, Maine,
Massachusetts, New Hampshire,
New York (all other counties),
Rhode Island, Vermont
Delaware, District of Columbia,
Maryland, Pennsylvania,
Virginia

Atlanta, GA 39901

Holtsville, NY 00501

Andover, MA 05501

Philadelphia, PA 19255

Illinois, lowa, Minnesota,

Missouri, Wisconsin Kansas City, MO 64999

Indiana, Kentucky, Michigan,

Ohio West Virgina Cincinnati, OH 45999

Kansas, New Mexico, Oklahoma,
Texas

‘Rlaska, 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

California (all other counties),
Hawaii

Austin, TX 73301

Ogden, UT 84201

Fresno, CA 93888

‘Alabama, Arkansas, Louisiana,

Mississippi, North Carolina, Memphis, TN 37501

Tennessee

American Samoa Philadelphia, PA 19255.
Commissioner of Taxes

Guam 855 West Marine Drive
Agana, GU 96910

Northern Mariana Islands vadetoni 7

(Conaronennat they Philadelphia, PA 19255

Puerto Rico (or if excluding

income under section 933) phitadelphia, PA 19255

Virgin Islands:
‘Nonpermanent residents
Vil. Bureau of Internal
, Revenue
Virgin islands: Lockhart Garden No. 1A
Permanent residents Kockhart Garden
St. Thomas, VI 00802
Foreign country:

USS. citizens and those filing
Form 2555 or Form 4563,
even if you have an A.P.O.
orF.P.O. address.

Philadelphia, PA 19255

Miami—Atlanta, GA 39901

New York—Holtsville, NY 00501
San Francisco—Fresno, CA 93888
Seattle—Ogden, UT 84201

A.P.O. or F.P.O.
address of:

Earnings To Which Exemption Applies. —
Only earnings from ministerial services are
exempt from self-employment tax.

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.

Example: The L Religious Board engages
Reverend M, an ordained minister, as director
of one of its departments. Reverend M
performs no other service. The L Religious
Board is an integral agency of O, a church
denomination. Reverend M is performing a
ministerial service.

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:

@ The organization for which you perform the
services did not arrange with your church for
your services.

‘@ You perform the same services for the
organization as other employees not
designated as you were.

You perform the same services before and
after the designation.

Earnings To Which Exemption Does Not
Apply.—Exemption from self-employment tax
does not apply to earnings from services other
than ministerial.

Example: N University engages Reverend K,
an ordained minister, to teach history. K
performs no other service for N, but
sometimes conducts marriages and funerals.
N University is neither a religious organization
nor an integral agency of a religious
organization. K’s ministerial superiors did not
assign K to teach at N University. K's teaching
is not a ministerial service. However,
conducting marriages and funerals is
ministerial service.

Exemption from self-employment tax does
not apply to earnings from the following
entities even if religious services are
conducted or sacerdotal functions are
ministered: the United States; a state,
if r possession of the U.S.; the District
ia; a foreign government; ora
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.
Vow of Poverty: Taxable Earnings.—If you
took a vow of poverty and are paid to perform
services for an organization other than the
church or an integral agency of it, no tax
exemption applies to these earnings. On this
income, you are treated as a regular employee
for Federal income tax withholding, social
security, and Federal unemployment tax.
Indicating Exemption on Form 1040.—If IRS
returned your application marked “approved”
and your only self-employment earnings are
from ministerial services, write
“Exempt—Form 4361" on the self-
employment line in the Other Taxes section of
Form 1040. If you have other self-employment
income, see Schedule SE (Form1040).

Specific Instructions
File three copies of Form 4361.

Enter your social security number. If you have
no number, file application Form SS-5,
Application for a Social Security Number Card,
with your local Social Security office. If you do
not receive your card in time, file Form 4361
and enter “applied for” in the space for the
number.

Line 2.—You may apply for exemption from
self-employment tax if you are:

e An ordained, commissioned, or licensed
minister of a church;

@ Amember of a religious order who has not
taken a vow of poverty;

 AChristian Science practitioner; or
 Acommissioned 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.

You must establish 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 establish that the body is a
church (or convention or association of
churches) described in section
170(b)(1)(AY(i).

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. For your application to be approved,
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.

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 this number from your church or
order.

Line 5.—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 1988, a valid Form
4361 filed by April 17, 1989, would apply to
1968 and all later years. However, refer to
Pub. 517 to see if you are entitled to a refund
of self-employment tax paid in earlier years.
Line 7.—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 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.

#0,S. Government Printing Office: 1988-242-473/80034