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Printable Form 8868 Louisville Kentucky: What You Should Know

II) I declare under penalties of perjury that I have filed a copy of this Certificate with the U.S. Department of the Treasury, the Office of Tax Policy, Tax Exemption Office with the United States Department of Treasury, Office of the Chief Counsel for the IRS (Form 1024), and with the Texas Department of Revenue and Texas Franchise Tax Board and have been provided an opportunity to submit supplemental information.  (III) I acknowledge in writing that I have read and agree to the enclosed Statement of Acceptance. In the event I do not agree to the statement of acceptance, I am directed to send it to the address on the enclosed receipt, or to contact me regarding any additional questions. (IV) I specifically authorize the Clerk-Treasurer of the City of Pearland to deliver the Certificate to a tax advisor in the Federal Income Tax Returns Field Office (hereinafter, the “Field Office”) who will be qualified to answer any questions I may have regarding the Certificate.  (V) I acknowledge in writing that on the date of the receipt of the Certificate and/or receipt of the Statement of Acceptance, I am not in violation of the provisions of 42 U.S.C. § 6721, and have not paid any federal income tax in excess of: (a) the maximum income tax for my filing status; (b) the maximum state income tax for my filing status; or (c) the maximum amount of federal and state income tax allowable for my filing status. (VI) I hereby make application for recognition of my exemption from Federal Income Tax as set forth in the Certificate. (VII) [Optional additional address for application for recognition of my exemption is below] Note to Tax Advisor: Under Penalty of perjury, I hereby designate the tax advisor designated by the person I selected to receive my Certificate of Release or Acceptance as my authorized representative, as described in Section 9. (This agent, as described in Section 9(E)(3)(A), may be any individual identified in Section 9(D)(1)(B) in the Certificate of Release or Acceptance.) All agents authorized by me are hereby empowered to act for me so long as they are not a tax attorney.

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