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Exemption Application 3500 - California

California FORM Exemption Application 3500 Organization Information California corporation number/ California Secretary of State file number FEIN Name of organization as shown in the organization s creating document Web address Street address (suite, room, or PMB no.) City State ZIP code Telephone Second telephone Fax Representative Information Name of representative Email address Street address (suite, room, or PMB no.) City State ZIP code Telephone Second telephone Fax General Questions Part I Organizational Structure If the listed documents are not provided, the organization s request for Exemption will be delayed, or denied.

Receive donations from another organization’s website Vehicle, boat, plane, or similar donations Government grant solicitations Foundation grant solicitations Other - Attach description Part VI Fund Raising If “Yes,” check all the fund-raising programs the organization conducts, or will conduct . mm / dd yyyy 1 a

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