Group Exemption Authorization Form

Certification Letter

Date:*
MM slash DD slash YYYY
Subordinate Organization:*
Parent Organization:*
Parent Organization Treasurer's Name:*
First Last
Parent Organization Treasurer's Contact Phone Number:*
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By signing below, we certify that the Subordinate Non-Profit Organization named above is recognized by the parent non-profit organization (organization whose name is listed on the determination letter from the IRS) and was submitted to the IRS for inclusion under the primary 501(c)3 held by the Parent Organization.
Parent Treasurer's Signature:*
Parent Treasurer's Name:*
Date:*
MM slash DD slash YYYY
Parent CEO's Signature:*
Parent CEO's Name:*
Date:*
MM slash DD slash YYYY

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