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Check the box for the return for which you am using this Form 8I and enter the applicable amount, If any, from the return. If you check the box
<br />on line Is, 2a, 3a, 4a, or Be, below, and the amount on that line for the Mum being filed with this form was blank, then leave line 1b, 2b, 3b, 4b, pr 6b,
<br />whichever is applicable, blank (do not enter -0.). But,'rf you entered .0. on the retum, then enter -O on the applicable line below. Do not complete more
<br />than 1 line in Part I.
<br />Is Form 990 check here ► ® Is Total revenue, If any (Forth 990, Part All, column (A), line 12),,,,,,,,,,,,,,,,,,,,, lb 5,586,931.
<br />2a Forth 990 rZ check hem ► EJ b Total revenue, N any (Form 990 EZ, line 9) .......................................... 21,
<br />3a Forth 1120-POL check here ► 0 Is Total tax (Form 1120-POL, line 22) ................................................ 3b
<br />4a Form 990 PF check here ► EJ b Tax based on Investment income (Form 990 PR Part VI, line 5) ........ 4b
<br />5a Form 8868 check here ► 0 b Balance Due (Form 8868, line 3c)............................................................ 51,
<br />Part II 1 Declaration and Signature Authorization of Officer
<br />Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of the organization's 2016
<br />electronic return and accompanying schedules and statements and to the beat of my knowledge and belief, they are two, correct, and complete. I
<br />further declare that the amount in Part I above is the amount shown on the copy of the organization's electronic return. I consent to allow my
<br />intermediate service provider, tmnsmider, or electronic Mum originator (ERO) to send the organization's return to the IRS and to receive from the IRS
<br />(a) an acknowledgement of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c)
<br />the dale of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct
<br />debit) entry to the financial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on this
<br />return, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at
<br />1-8883534537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the
<br />processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the
<br />payment. I have selected a personal identification number (PIN) as my signature for the organization's electronic return and, if applicable, the
<br />organization's consent to electronic funds withdrawal.
<br />Officer's PIN: check one box only
<br />®Iauthorize POTTER & COMPANY, P.A. toentarmy PIN 12345
<br />ERO firm name Enter five numbers, but
<br />do not enter all zeros
<br />as my signature on the organization's tax year 2016 electronically filed return. If I have indicated within this Mum that a copy of the return
<br />is being filed with a state agency(lies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to
<br />enter my PIN on the retum's disclosure consent screen.
<br />ED As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2016 electronically filed return. If I have
<br />indicated within this Mum that a copy of the return Is being filed with a state agencyges) regulating charities as part of the IRS Fed/State
<br />program, I will enter my PIN on the return's disclosure consent screen.
<br />Officer's signature ►
<br />Date ►
<br />Part III I Certification and Authentication
<br />ERO's EFIN/PIN. Enter your six -digit electronic fling identification
<br />number(EFIN) followed by your five digit selfselected PIN. 690873 0401
<br />do not anter all zeros
<br />I certify that the above numeric entry is my PIN, which is my signature on the 2016 electronically filed Mum for the organization indicated above. I
<br />confine that I am submitting this Mum In accordance with the requirements of Pub. 416% Modernized aFile (MeF) Information for Authorized IRS
<br />e -file Providers for Business Retums.
<br />ERO'sslgndure►POTTER & COMPANY, P.A. Date III
<br />ERO Must Retain This Form - See Instructions
<br />Do Not Submit This Form To the IRS Unless Requested To Do So
<br />LHA For Paperwork Reduction Act Notice, see instructions.
<br />6211051 09ao-16
<br />m8978 -W (2016)
<br />Attachment number 21n
<br />1-2 Page 220
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