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BCA Relationship: <br />Authorized Representative Signature <br />Name (Print) <br />DateTitle <br />Buddhist Churches of America: National Headquarters Staff Use Only <br />Receiving Employee Signature <br />Date Filed with IRS <br />Buddhist Churches of America <br />Group Exemption Authorization Agreement <br />Federal Tax Identification Number <br />T J Sangha <br />| | District Council <br />__________ <br />y/zo/'20/2- <br />Date <br />Name (Print) <br />7/// z/z <br />Date Received <br />will notify the BCA: National Headquarters in <br />exemption. The Organization is not a i <br />office or other political campaigns. <br />Authorized Representative Signature <br />Name (Print) <br />Title <br />'bdOO^ Cf CM I <br />Organization Name <br />|7] Member Temple <br />] | Affiliated Organization <br />Tzegy______ <br />Formal Mailing Address <br />Actual Mailing Address (if different) <br />Primary Phone Number <br />I, as an authorized representative, hereby grant full authority to the Buddhist Churches of <br />America: National Headquarters to include the Organization in the Group Exemption granted by <br />the IRS. The Organization has not applied for nor maintains an individual group exemption and <br /> l.i writing if it wishes to withdraw from the group <br />private foundation, does not endorse candidates for public