Preview Nonprofit Annual Report

Indiana Department of Revenue

Indiana Nonprot Organization's Annual Report

For the Calendar Year or Fiscal Year

Beginning _____/_____/_____ and Ending _____/_____/_____

Due on the 15th day of the 5th month following the end of the tax year.

NO FEE REQUIRED.

Name of Organization Telephone Number

Address County IndianaTaxpayerIdenticationNumber

City State ZipCode FederalIdenticationNumber

PrintedNameofPersontoContact   Contact'sTelephoneNumber

Ifyouarelingafederalreturn,attachacompletedcopyofForm990,990EZ,or990PF.

Note: Ifyourorganizationhasunrelatedbusinessincomeofmorethan$1,000asdenedunderSection 513oftheInternalRevenueCode,you

must also le Form IT-20NP.

Current Information

1.

HaveanychangesnotpreviouslyreportedtotheDepartmentbeenmadeinyourgoverninginstruments,(e.g.)articlesofincorporation,

bylaws,orotherinstrumentsofsimilarimportance?Ifyes,attachadetaileddescriptionofchanges.

2. Indicatenumberofyearsyourorganizationhasbeenincontinuousexistence.__________.

3. Attachaschedule,listingthenames,titlesandaddressesofyourcurrentofcers.

4. Brieydescribethepurposeormissionofyourorganizationbelow.

EmailAddress:

I declare under the penalties of perjury that I have examined this return, including all attachments, and to the best of my knowledge and belief, it

is true, complete, and correct.

SignatureofOfcerorTrustee Title Date

NameofPerson(s)toContact DaytimeTelephoneNumber

Important:Pleasesubmitthiscompletedformand/orextensionto:

IndianaDepartmentofRevenue,TaxAdministration

P.O.Box6481

Indianapolis,IN46206-6481

Telephone:(317)232-0129

Extensions of Time to File

TheDepartmentrecognizestheInternalRevenueServiceapplicationforautomaticextensionoftimetole,Form8868.Please forward a copy of

your federal extension, identied with your Nonprot Taxpayer Identication Number (TID), to the Indiana Department of Revenue, Tax

Administration by the original due date to prevent cancellation of your sales tax exemption.

AlwaysindicateyourIndianaTaxpayerIdentication

numberonyourrequestforanextensionoftimetole.

Reportspostmarkedwithinthirty(30)daysafterthefederalextensionduedate,asrequestedonFederalForm8868,willbeconsideredastimely

led.AcopyofthefederalextensionmustalsobeattachedtotheIndianareport.Intheeventthatafederalextensionisnotneeded,ataxpayermay

requestinwritinganIndianaextensionoftimetolefromthe:IndianaDepartmentofRevenue,TaxAdministration,P.O.Box6481,Indianapolis,

IN46206-6481,(317)232-0129.

IfFormNP-20orextensionisnottimelyled,thetaxpayerwillbenotiedbytheDepartmentpursuanttoI.C.6-2.5-5-21(d),toleFormNP-20.If

withinsixty(60)daysafterreceivingsuchnoticethetaxpayerdoesnotleFormNP-20,thetaxpayer'sexemptionfromsalestaxwillbecanceled.

NP-20

State Form 51062

(R7 / 8-13)

Checkif: Change of Address

Amended Report

 FinalReport:Indicate

 DateClosed______

mm/dd/yyyy mm/dd/yyyy

*25413111594*

25413111594

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