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Election/Revocation of Election by an Eligible
Form 5768 Section 501(c)(3) Organization To Make
(Rev. September 2016) Expenditures To Influence Legislation
Department of the Treasury (Under Section 501(h) of the Internal Revenue Code) For IRS
Internal Revenue Service ▶ Information about Form 5768 and its instructions is at www.irs.gov/form5768. Use Only ▶
Name of organization Employer identification number
Number and street (or P.O. box no., if mail is not delivered to street address) Room/suite
City, town or post office, and state ZIP + 4
1 Election— As an eligible organization, we hereby elect to have the provisions of section 501(h) of the Code, relating to
expenditures to influence legislation, apply to our tax year ending and all
subsequent tax years until revoked. (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 section 501(h) of the Code,
relating to expenditures to influence legislation, apply to our tax year ending and
all subsequent tax years (until a new election is made). (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, I declare that I am authorized to make this (check applicable box) ▶ election revocation
on behalf of the above named organization.
(Signature of officer or trustee) (Type or print name and title) (Date)
General Instructions the election or revocation applies in item b. An integrated auxiliary of a church or
1 or 2, as applicable, and sign and date of a convention or association of
Section references are to the Internal the form in the spaces provided. churches, or
Revenue Code. Eligible organizations. A section c. A member of an affiliated group of
Section 501(c)(3) states that an 501(c)(3) organization is permitted to organizations if one or more members
organization exempt under that section make the election if it is not a of such group is described in aor ofb
will lose its tax-exempt status and its disqualified organization (see below) and this paragraph.
qualification to receive deductible is described in: Affiliated organizations. Organizations
charitable contributions if a substantial 1. Section 170(b)(1)(A)(ii) (relating to are members of an affiliated group of
part of its activities are carried on to educational institutions), organizations only if (1) the governing
influence legislation. Section 501(h), instrument of one such organization
however, permits certain eligible section 2. Section 170(b)(1)(A)(iii) (relating to
501(c)(3) organizations to elect to make hospitals and medical research requires it to be bound by the decisions
limited expenditures to influence organizations), of the other organization on legislative
legislation. An organization making the 3. Section 170(b)(1)(A)(iv) (relating to issues, or (2) the governing board of one
election will, however, be subject to an organizations supporting government such organization includes persons (i)
excise tax under section 4911 if it schools), who are specifically designated
representatives of another such
spends more than the amounts 4. Section 170(b)(1)(A)(vi) (relating to organization or are members of the
permitted by that section. Also, the organizations publicly supported by governing board, officers, or paid
organization may lose its exempt status charitable contributions), executive staff members of such other
if its lobbying expenditures exceed the 5. Section 170(b)(1)(A)(ix) (relating to organization, and (ii) who, by aggregating
permitted amounts by more than 50% agricultural research organizations), their votes, have sufficient voting power
over a 4-year period. For any tax year in 6. Section 509(a)(2) (relating to to cause or prevent action on legislative
which an election under section 501(h) is organizations publicly supported by issues by the first such organization.
in effect, an electing organization must admissions, sales, etc.), or For more details, see section 4911 and
report the actual and permitted amounts
of its lobbying expenditures and grass 7. Section 509(a)(3) (relating to section 501(h).
roots expenditures (as defined in section organizations supporting certain types Note: A private foundation (including a
4911(c)) on its annual return required of public charities other than those private operating foundation) is not an
under section 6033. See Part II-A of section 509(a)(3) organizations that eligible organization.
Schedule C (Form 990 or Form 990-EZ). support section 501(c)(4), (5), or (6) Where to file. Mail Form 5768 to:
Each electing member of an affiliated organizations).
Department of the Treasury
group must report these amounts for Disqualified organizations. The Internal Revenue Service Center
both itself and the affiliated group as a following types of organizations are not Ogden, UT 84201-0027
whole. permitted to make the election:
To make or revoke the election, enter a. Section 170(b)(1)(A)(i) organizations
the ending date of the tax year to which (relating to churches),
Cat. No. 12125M Form 5768 (Rev. 9-2016)
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