Tobacco Documents Online

SE MARY ST4T]F- EXPIRA'DLON DATE ~ - 3'7' (,- 'i `i 0 ._ L- 1- MAR 1991 A 0 1 - Me- APPLICATION' FOR STATUS AS A C~.i-- PiJBLIC BENEFIT NONPROFIT CORPORATION Ft1.ED RETURN TO: ~ E PO NAT N ONS DIVISION M1f~ A p 5 W~~ Ff~I 21 ~ IC~ARY OF STJA~TE OLYMFIA WA 9850s 0414 . STATE OF ft$htINIGT0IV CK Religious organization : R AMT .~ (1) Name of corporation: Smoking Policy Institute L/ (2) Unified Business Identifier (UBI) number or state Department of Revenue number: f+(10 638 3f3 -3 (3) Is the corporation a non-stock, nonprofit corporation, incorporated under Chapter 24.03 RCW? 10 YES D NO Fl'UNKNOWh] (4) Please check the appropriate box regarding recognition by the Internal Revenue Service (IRS) as tax exempt under Section 501(c)(3): [i] The corporation has received from the IRS a letter of determination of tax exempt status under Section 501(c)(3) Date received: Septmber 22. I 9$L_ ~ The corporation is an entity that is not required to apply for tax exempt status under Section 501(c)(3) Why is the corporation not required to apply for tax exempt status? 0 (] Other 01~ wo ~ The carporatim is in the process of applying for tax exempt status under Section 501(c)(3) Date Form 1023 submitted to the IRS: • E] The corporation is not recognized as tax exempt by the IRS (5) Does the corporation wish to have the term "Public Benefit" affixed to its corporate name? n YES ® NO Lj -~- ~ X SIGNA OF OFFICFR vti.Q pre-s i A -e L,-* 5_--q 0 CASH ~_ N , I - tN Ld r ~ X 71712 OF OFFICER DATE FORM IS SIGNED -14 Document must be signed' by an officer of the corporation. Under state law, an officer is designated as either President, Vice-President, Secretary or Treasurer. R~E ty~CEEIVE~D .'7~fc-nWpFCV w'TTOh C avt). 32 4 - 4w,N'y