Application for Recognition of Exemption Under 501(c) of the Internal Revenue Code
Most organizations seeking exemption from federal income tax under section 501(c)(3) are required to complete and submit an application.

We will use the information provided herein to complete your 1023 application.

If you have any questions, please give us a call at 706.662.8881 or email us at contactus@hillardcpa.com
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Email *
Full Name of Organization: *
EIN *
Enter your organization's nine-digit EIN.
Contact Person: *
Enter the name and title of the person to contact if more information is needed.  If you would like to list Dennice Hillard of Hillard Tax & Accounting as the contact person, you may do so.
Phone number: *
Please list a daytime telephone number for the person listed above.  If you list Dennice Hillard, please enter 706.662.8881.
List the names, titles, and mailing address of your officers, directors, and/or trustees. *
Enter the full names, titles (i.e., President, Treasurer, etc.), and mailing addresses of your officers, directors, and/or trustees. You may use the organization's address for mailing.
Organization's Website:
Enter your current website address, as of the date of filing this application. If you do not maintain a website, enter “N/A” (not applicable).
Entity Type: *
State of Formation: *
Purpose(s) Clause: *
State the purpose of your organization's exemption under 501(c)(3).  Those purposes are:  charitable, religious, educational, scientific, literary, testing for public safety, fostering national or international amateur sports competition, and preventing cruelty to children or animals.
State your organization's mission: *
Example:   In Rev. Rul. 69-161, 1969-1 C.B. 149, a nonprofit legal aid society that was organized and operated for the purpose of providing free legal services to indigent persons who were otherwise financially incapable of obtaining such services, qualified for exemption under section 501(c)(3) as a charitable organization providing relief to the poor and distressed.
Foundation Classification: *
Have your annual gross receipts exceeded $50,000 in any of the past 3 years? *
Do you project that your annual gross receipts will exceed $50,000 in any of the next 3 years? *
Does the fair market value of your assets exceed $250,000? *
If you have 'Yes' to ANY of the above questions, select 1023 Long Form.  *Any additional fees will be billed upon completion of the engagement.
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A copy of your responses will be emailed to the address you provided.
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