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Form 12508 online LA: What You Should Know

Everest Foundation (ATTN: Nomination) Attn: Amy Schumacher P.O. Box 907 Kernersville, MA 02791 Or send your nomination to: Everest Foundation (ATTN: Submission) ATTN: Amy Schumacher 14 Church Street Kernersville, MA 01749 The following are listed on the form as acceptable references. Name: A name will suffice as the reference if your spouse does not qualify. We suggest you keep the name simple, as you do not wish to jeopardize your relationship with your spouse. Date of birth: This should be the date of birth of your spouse, that will be indicated at your request by the Department of Revenue. If your spouse does not live with you, the date of birth can also be a postal code or state of where your spouse was born. Contact information: This will include name, telephone number, e-mail address and other such information. As your preference dictates, there is no need to provide a phone number, please give us this information. If you prefer to remain completely anonymous, then it is completely acceptable. Cultural/racial background: The information submitted here should not appear as such, but we feel this is important as we will be considering the criteria of ancestry. What you can do: By providing us information in this manner, not only will we be able to evaluate the circumstances of your spouse but also the circumstances of the whole household. We want you to be as honest as possible. Please take the time to thoroughly fill out this form. Our employees may ask to interview a member of the family in order to verify the identity of the person seeking a nomination for us to grant a special tax exemption. As you note in the box below, you have the right to consult with an attorney before answering any of the questions listed in this form. Name, address, and email address: I understand that the information collected from these forms will be used by the Department of Revenue for determining eligibility to receive the special tax exemption. I hereby acknowledge that if I submit this form the Department of Revenue may contact me with questions and/or may contact my household for additional information related to my case. I further understand that in submitting my information, I am consenting to my information being forwarded in connection with the Department of Revenue' determination of eligibility.

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