Affidavit of a Church (Tennessee)
This is an affidavit of a church in Tennessee. The form provided here is simply a sample of what the actual Form SS 4459 looks like.
For Office Use Only
AFFIDAVIT
Corporate Filings
312 Eighth Avenue North
6th Floor, William R. Snodgrass Tower
Nashville, TN 37243
THIS IS TO CERTIFY UNDER THE PENALTIES OF PERJURY THAT
_____________________ IS A CHURCH AND THE INTERNAL REVENUE SERVICE CONTINUES TO HONOR ITS CLAIM TO AN AUTOMATIC EXEMPTION FROM PAYMENT OF FEDERAL INCOME TAX UNDER ¶501(C)(3) OF THE INTERNAL REVENUE CODE (26 U.S.C., ¶501(C)(3)). I FURTHER CERTIFY THAT THE AFORESAID CORPORATION IS EXEMPT AND IS CURRENTLY OPERATING UNDER SAID EXEMPTION, AND I KNOW OF NO VIOLATIONS OF FEDERAL STATUTES AND RULES AND REGULATIONS OF FEDERAL DEPARTMENTS INCLUDING THE INTERNAL REVENUE SERVICE WHICH WOULD JEOPARDIZE THIS EXEMPTION. THIS AFFIDAVIT IS SUBMITTED IN LIEU OF PROVIDING THE NAMES AND ADDRESSES OF THE PRINCIPAL OFFICERS AND BOARD OF DIRECTORS OF THIS CORPORATION ON THE ANNUAL REPORT REQUIRED BY TENNESSEE CODE ANNOTATED SECTION 48-66-203.
SIGNATURE OF PRESIDENT OR OTHER PRINCIPAL OFFICER OF THE CORPORATION
_____________________
DATE _____________________
STATE OF _____________________
COUNTY OF _____________________
SWORN TO AND SUBSCRIBED BEFORE ME
THIS __________________ DAY OF ______________, __________
NOTARY PUBLIC _____________________
DATE COMMISSION EXPIRES _____________________