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Form 1 024 Application for Recognition of Exemption OMB No.1545-0057
<br /> (Rev.January 2018) Under Section 501(a) If exempt status is approved,
<br /> this application will be open
<br /> DepartmentInternalRevenue f the ServiceTry ►Go to www.irs.gov/Form1024 for instructions and the latest information. for public inspection.
<br /> 9
<br /> Read the instructions for each Part carefully. A User Fee must be attached to this application.
<br /> If the required information and appropriate documents are not submitted along with Form 8718 (with payment of the
<br /> appropriate user fee), the application may be returned to the organization.
<br /> Complete the Procedural Checklist that follows the form.
<br /> Part I. Identification of Applicant Must be completed by all applicants; also complete appropriate schedule.
<br /> Submit only the schedule that applies to your organization. Do not submit blank schedules.
<br /> Check the appropriate box below to indicate the section under which the organization is applying:
<br /> a ❑ S• ection 501(c)(2)—Title holding corporations(Schedule A)
<br /> b ❑ Reserved for future use
<br /> c ❑ Section 501(c)(5)—Labor,agricultural,or horticultural organizations(Schedule C)
<br /> d ❑ Section 501(c)(6)—Business leagues,chambers of commerce,etc.(Schedule C)
<br /> e ❑ Section 501(c)(7)—Social clubs(Schedule D)
<br /> f ❑ S• ection 501(c)(8)—Fraternal beneficiary societies,etc.,providing life,sick,accident,or other benefits to members(Schedule E)
<br /> g 111 Section 501(c)(9)—Voluntary employees'beneficiary associations(Parts I through IV and Schedule F)
<br /> h ❑ Section 501(c)(10)—Domestic fraternal societies,orders,etc.,not providing life,sick,accident,or other benefits(Schedule E)
<br /> i ❑ Section 501(c)(12)—Benevolent life insurance associations,mutual ditch or irrigation companies,mutual or cooperative telephone
<br /> companies,or like organizations(Schedule G)
<br /> j ❑ Section 501(c)(13)—Cemeteries,crematoria,and like corporations(Schedule H)
<br /> k ❑ Section 501(c)(15)—Mutual insurance companies or associations,other than life or marine(Schedule I)
<br /> I ❑ S• ection 501(c)(17)—Trusts providing for the payment of supplemental unemployment compensation benefits(Parts I through IV and Schedule J)
<br /> m ❑ Section 501(c)(19)—A post,organization,auxiliary unit,etc.,of past or present members of the Armed Forces of the United States(Schedule K)
<br /> n ❑ Section 501(c)(25)—Title holding corporations or trusts(Schedule A)
<br /> la Full name of organization(as shown in organizing document) 2 Employer identification number(EIN)(if
<br /> none,see Specific Instructions)
<br /> City of Everett VEBA Trust
<br /> 8 3 6 3 4 6 0 3 7
<br /> 1 b c/o Name(if applicable) 3 Name and telephone number of person to be
<br /> contacted if additional information is needed
<br /> lc Address(number and street) Room/Suite
<br /> 2930 Wetmore Avenue,Suite 5-A
<br /> Id City,town or post office,state,and ZIP+4.If you have a foreign address,see Specific
<br /> Instructions for Part I.
<br /> Scott A.Wold,Esq.
<br /> Everett,WA 98201 ( 763 ) 503-6620
<br /> le Web site address 4 Month the annual accounting period ends 5 Date incorporated or formed
<br /> December 01/10/2019
<br /> 6 Did the organization previously apply for recognition of exemption under this Code section or under any other section of the Code? ❑Yes ❑✓ No
<br /> If"Yes,"attach an explanation.
<br /> 7 Has the organization filed Federal income tax returns or exempt organization information returns'? . . . . . . . . ❑✓ Yes ❑No
<br /> If"Yes,"state the form numbers,years filed,and Internal Revenue office where filed.
<br /> Form 990,2019,Dept of Treasury,IRS Center,Ogden,UT 84201-0027
<br /> 8 Check the box for the type of organization.ATTACH A CONFORMED COPY OF THE CORRESPONDING ORGANIZING DOCUMENTS TO
<br /> THE APPLICATION BEFORE MAILING.
<br /> a ❑ Corporation— Attach a copy of the Articles of Incorporation(including amendments and restatements)showing approval by the
<br /> appropriate state official;also attach a copy of the bylaws.
<br /> b ❑✓ T• rust— Attach a copy of the Trust Indenture or Agreement,including all appropriate signatures and dates.
<br /> c ❑ Association— Attach a copy of the Articles of Association,Constitution,or other creating document,with a declaration(see instructions)
<br /> or other evidence that the organization was formed by adoption of the document by more than one person.Also include a
<br /> copy of the bylaws.
<br /> If this is a corporation or an unincorporated association that has not yet adopted bylaws,check here . . . . . . . . ► ❑
<br /> I declare under the penalties• • )hat I am authorized to sign this application on behalf of the above organization,and that I have examined this
<br /> application,includin• •- • •.n g schedules and attachments,and to the best of my knowledge it is true,correct,and complete.
<br /> PLEASE cos,‘__vel,trigi4JSIGN Aytr L l � y/�.
<br /> HERE
<br /> • ature) (Type or print name and title or authority of signer) (Date)
<br /> For Paperwork Reduction Act Noti see instructions. Catalog No.12343K Form 1024(Rev.1-2018)
<br /> aff101- hit40/
<br /> Office of the City Attorney
<br /> ( APPROVED AS TO FORM
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