Form 940. (1074)

Statements with Respect to Certain Activities

the form 4720 d question X2), 1(2), or 10(2) is answered "No," ar question (3) ((2), or M(1) or (2) in ammered "Yes"

A During the to 'ble year, have you (8) attempted to influence any national, State, or local legislation, or (b) par ticipated or intervened in any political campaign?

# "Yes," attach a detailed description of such activities and copies of any materials published or distributed by the organization in connection with such activities

Have you engaged in any activities which have not previously been reported to the Internal Revenue Service' "You," attach a detailed description of such activities.

C Have any changes not previously reported to the internal Revenue Service been made in your governing instru ment, articles of incorporation, or bylaws, or other instruments of similar import?

#Tra" attach a copy of the changes.

D Have you fled a tax return on Form 990-T for this year?

E Was there a substantial contraction during the year?

If "Yes," attach a schedule for the disposition(s) for the year(s) showing type of asset disposed of the date si disposed, the cost or other basis, the fair market value on date of disposition and the names and addresses of the recipients of the assets distributed. (See general instruction Q)

Did you hie the annual report required by section 6056 (see Form 990-AR for instructions)!

Are the requirements of action 508(e) (relating to governing instruments) satisfied?

(See general instruction t)

If "Yes," have such requirements been satished by:

(1) Language in the governing instrument (original or as amended), or.

(2) Enactment of Stat legislation effectiv ly amending the governing instrument and the governing instrument contains no mandatory directions which are in conflict with such State legislation

N (1) Enter the names of the States required to be listed by general instruction J

STATE OF NEW YORK

(2) Have you furnished a copy of Form 990-AR (or equivalent report) to the Attorney General of each State as required by general instruction K? .

"No," attach explanation.

I Are you claiming status as an operating foundation within the meaning of 4942(j)(3) for calendar year 1974 or hacal year beginning in 19747 (see instructions for Part XII)

If "Yes," complete Part XII.

J Self-dealing (section 4941):

(1) Have you engaged in any of the following acts during the year other dianth.

(a) Sale, an

(b) Borrowin

(c) Furnishi

(d) Payment

(0) Transfer
(1)

irectly, with one or mare

Our income or assets

ed in sect on 4946) other
mination of his government

1 you engaged excepted

ed in acts of se' deating in

Part V, of the instructions,

1 operating foundation

nd (c). Part XI) for tax.

2

3

2

to incorrect valuation

(2) If any of que acts describe

(3) Have you, in

years beginning
and that were

K Taxes on failure t

as defined in 4943

(1) Did you at the

able year(s) If "Yes," inse (2) "Yes," to (1 of assets) with

(3) If the provisio years here and

(1) Did you hold m Part V "Definit

(2) If "Yes," have May 26, 1969, tax under sectic

M Taxes on investmen

(1) Did you invest i exempt purpos

(2) Did you invest, i the carrying ou before the first

112

se (see instruction 8.