Form Schedule N (Form 9 Schedule N (Form 9 Liquidation, Termination, Dissolution or Significant Dis

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SCHEDULE N
(Form 990 or 990-EZ)

I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE N (FORM 990), PAGE 1 of 4
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: FACE ONLY
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 279 mm (11")  216 mm (81⁄2 ")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Action

Date

Signature

O.K. to print
Revised proofs
requested

OMB No. 1545-0047

Liquidation, Termination, Dissolution or Significant Disposition of Assets

2008

To be completed by organizations that answer “Yes” to Form 990, Part IV, lines 31 or 32 or Form 990-EZ, line 36.
Department of the Treasury
Internal Revenue Service

䊳

Name of the organization

Part I
1

Open to Public
Inspection

Attach certified copies of any articles of dissolution, resolutions or plans.

Employer identification number

Liquidation, Termination or Dissolution. Complete this part if the organization answered “Yes” to Form 990, Part IV, line 31. (Use Schedule N-1 if
additional space is needed.)
(a) Description of asset(s)
distributed or transaction
expenses paid

(b) Date of
distribution

(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses

(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses

(e) EIN of recipient

(f) Name and address of recipient

(g) IRC Code section
of recipient(s) (if
tax-exempt) or type
of entity

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Yes No
2
a
b
c
d
e

Did or will any officer, director, trustee, or key employee of the organization:
Become a director or trustee of a successor or transferee organization?
Become an employee of, or independent contractor for, a successor or transferee organization?
Become a direct or indirect owner of a successor or transferee organization?
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s liquidation, termination, or dissolution?
If the organization answered “Yes” to any of the questions in this line, provide the name of the person involved and explain in Part III.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50087Z

2a
2b
2c
2d

Schedule N (Form 990 or 990-EZ) 2008

1
I.R.S. SPECIFICATIONS
TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
SCHEDULE N (FORM 990), PAGE 2 of 4
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: FACE ONLY
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 279 mm (11")  216 mm (81⁄2 ")
PERFORATE: NONE
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 2

Schedule N (Form 990 or 990-EZ) 2008

Part I
3
4a
b
5a
b
6
7a
b
c

Liquidation, Termination or Dissolution (Continued)

Note: If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B) should equal -0-.
Did the organization distribute its assets in accordance with its governing instruments? If “No,” describe in Part III
Did the organization request or receive a determination letter from EO Determinations that the organization’s exempt status was terminated?
(If “Yes,” provide the date of the letter.
)
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate?
If “Yes,” did the organization provide such notice?
Did the organization discharge or pay all liabilities in accordance with state laws?
Did the organization have any tax-exempt bonds outstanding during the year?
Did the organization discharge or defease tax-exempt bond liabilities in accordance with the Internal Revenue Code and state laws?
If “Yes,” describe in Part III how the organization defeased or otherwise settled these liabilities. If “No,” explain in Part III.

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Yes No
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4a
5a
5b
6
7a
7b

Part II

Sale, Exchange, Disposition or Other Transfer of more than 25% of the Organization’s Assets. Complete this part if the organization answered
“Yes” to Form 990, Part IV, line 32. (Use Schedule N-1 if additional space is needed.)

1

(a) Description of asset(s)
distributed or transaction
expenses paid

(b) Date of
distribution

(c) Fair market value of
asset(s) distributed or
amount of transaction
expenses

(d) Method of
determining FMV for
asset(s) distributed or
transaction expenses

(e) EIN of recipient

(f) Name and address of recipient

(g) IRC Code section
of recipient(s) (if
tax-exempt) or type
of entity

Yes No
2
a
b
c
d
e

Did or will any officer, director, trustee, or key employee of the organization:
Become a director or trustee of a successor or transferee organization?
Become an employee of, or independent contractor for, a successor or transferee organization?
Become a direct or indirect owner of a successor or transferee organization?
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets?
If the organization answered “Yes” to any of the questions in this line, provide the name of the person involved and explain in Part III.

2a
2b
2c
2d

Schedule N (Form 990 or Form 990-EZ) 2008

1
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE N (FORM 990), PAGE 3 of 4 (page 4 is blank)
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 835 mm (327⁄8 "),
PERFORATE: ON FOLD
FOLD TO: 216 mm (81⁄2 ") x 279 mm (11")

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Schedule N (Form 990 or 990-EZ) 2008

Part III

Page

3

Supplemental Information. Complete this part to provide the information required by Part I, lines
2e, 7c, or Part II, line 2e, and any additional information.

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Schedule N (Form 990 or 990-EZ) 2008