Form CM-1041 – GF.wels.net

• The purpose of this form is to request federal tax exempt status in WELS Group 1773.
• A field marked with a red asterisk is required.

In order to be granted Federal Income Tax Exemption, our organization, as an affiliated unit, requests that the synod add our name to its roster of subordinate elements for approval by the IRS in its 501(c)(3) group exemption letter.
Corporate name of reporting unit*
Current address*
Address line 1 Address line 2 City State Zip code
Federal Employer Identification Number (EIN)
Select one status*
- We have an EIN
- We will be applying for a number soon
Enter federal EIN*
Confirm federal EIN*
Federal Tax Exempt Status
Does your organization have its own IRS determination letter approving tax-exempt status such as Form 1023 or 1023-EZ?*
(Most WELS churches do not have a separate IRS determination letter.)
- Yes
- No
Upload your letter(s) from the IRS with your EIN and/or tax exempt status. Failure to do so will delay our process.*
• Sample IRS letter
• File extensions allowed: pdf, doc, docx, jpg, png
• Maximum file size allowed: 4MB
Drop files here or

Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 4 MB, Max. files: 4.
Signature
Date*
MM slash DD slash YYYY
Group Exemption Authorization*
I agree to the group exemption authorization.
Group Exemption Authorization

The undersigned organization hereby authorizes the Wisconsin Evangelical Lutheran Synod (WELS) to include it as a subordinate organization under WELS’s Internal Revenue Service group exemption ruling.
The organization affirms that it is organized and operated in a manner consistent with the requirements of the group exemption and acknowledges that it is subject to the general supervision or control of WELS for purposes of maintaining federal tax-exempt status.
This authorization is effective as of the date signed below.
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Group Exemption Authorization description
Group Exemption Authorization The undersigned organization hereby authorizes the Wisconsin Evangelical Lutheran Synod (WELS) to include it as a subordinate organization under WELS’s Internal Revenue Service group exemption ruling. The organization affirms that it is organized and operated in a manner consistent with the requirements of the group exemption and acknowledges that it is subject to the general supervision or control of WELS for purposes of maintaining federal tax-exempt status. This authorization is effective as of the date signed below.
Pastor or officer signature*
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Title/position*
Name*
Prefix First Last
E-mail*
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Data Privacy & Permission
I AGREE with the terms of the WELS Privacy Policy.
NOTE TO EU CITIZENS, RESIDENTS, TOURISTS, AND OTHER PERSONS TEMPORARILY IN THE EU:

By submitting this form you consent to any and all information you provide and submit via the site being sent to the United States of America. The United States has not sought nor received a finding of “adequacy” from the European Union under Article 45 of the GDPR. WELS relies on derogations for specific situations as set forth in Article 49 of the GDPR. You are also informed that the United States presently does not have an adequate level of personal data protection as determined by the European Commission’s adequacy decision on October 6, 2015 (case c-362/14) and articulated in the European Union’s General Data Protection Regulation and has not received a similar designation of adequacy by any other foreign data protection authority. You agree to the transfer of your data and personal data to the United States, however, to be used in accordance with WELS Privacy Policy.

Risk Management: [email protected] or 414-256-3260 | Privacy policy
Ref: Form CM-1041