|
.",. 8879-TE
<br />Depa(ment of lhe Treasury
<br />lnternal Revenue Service
<br />IRS e-file Siqnature Authorizationfor a Tax Exempt Entity
<br />For calendar year 2021, or fiscal year beginning
<br />ONIB No. 1545-0047
<br />,2021, and ending
<br />) Do not send to the lRS, Keep for your records.
<br />Go io
<br />2021
<br />ormB879TE lor the latest information.
<br />of Iiler EIN or SSN
<br />s6-1 95s629REBUILDING TOGETHER OF THE TRIANGLE
<br />Name and title of officer or person subiect to tax DAN SARGENT
<br />DIRE
<br />1a Form gg0 check here ......... > U b2a Form990-EZ checkhere ... >E b3a Form 1120-POL check frere ) l--l b4a Form990-PF checkhere ... >E b5a Form3363checkhere ......>E b
<br />6a Form 990-T check here ...... > E b7a Form4T?0 check here ...... > f] b8a Form5227 checkhere ...... >n b9a Form 5330 check here ...... > f] b
<br />Total revenue, if any (Form 990, Part Vlll, column (A), line 12)h 2,78L,755.
<br />Total revenue, if any (Form 990-EZ, line 9)
<br />Tax due (Form 5330, Part ll, line i9)
<br />Under penalties of perjury, I declare that I am an officer of the above entity or I am a person subject to tax with respect to (name
<br />of entity), (ElN)-'_---- and that I have examined a copy of the
<br />::f,Li1r"":-l?Xf#X':il: -L,"flfi}Ig-.*31!g.^i!9^.P1?T?!l!r l?9r to the best or my knowredge and betier, they are true, correct, and
<br />Checktheboxforthereturn.fo.rwhichyoUareusingthisFormBB79-TEandentertheapp|icableamount,it,
<br />::'ll"t::P^l].:."Tf^"1:.: 1",,,::._::9,::]:: f:j 3lfll"Jlg'Il ?nt?l whore doilars onry. rr yo, crrecx trre nox on [ne 1a, 2a,3a,4a, 5a,6a,7a, Ba, ea,or 1oa below, and the amount on that line for the return being filed with this form was blink,'then leave line ;;6;;, il,fi, ;i, ;;, ;;, 6;, ;; ;3t:whichever is applicable, blank (do not enter'o). But, if you entered -o- on the return, then enter-0. on the applicable Iine beiow.' Do not complete morethan one line in Part l.
<br />Total tax (Form 1 120.POL, tine 22) ........
<br />Tax based on investment income (Form 990-pF, paft V, line 5)
<br />Balance due (Form 8868, line 3c) . .... ...
<br />Total tax
<br />Total tax
<br />FMV of
<br />WOOTEN & HAYWOOD LLP
<br />2b
<br />3b
<br />4b
<br />5b
<br />6b
<br />7b
<br />8b
<br />9b
<br />complete. I rurther declare that tne an{ou"niin p;nl;bli;e is ih" ;;;;i:hil;ffi;,;;i ;i'i##;Ltii.","i;h:'i"J;'."Jiifr :frffi?;'"intermediate service provider, transmitter, or electronic,return originator 1fnol io-seno tne'ri:turn toiiie iils'ano to receive from it',E rnb 1u; unacknowledqementof receiptorreasonfoirejectionof thetransmis.ion,'lulLhdfoasonforSnygg[yinproc]ssingthereturnorrefund,and (c)thedate
<br />Bl,li{j J,i,l?;lfflJ'i"1?l?l,l*l:?,:1:"1**:;l:::ly_::f:{q::igt l".-Fil;it;iAs;nii6;;irrt;$';6;tronic runds withdrawar (direct debit)
<br />auKlrowreogemenr oT recelpt or reason tor reiection of the transmission, (b) the reason for any d9l3y in processing tne return-or iljtr"O, aiO' iiof any refund.' lf appJicable, I authorize the u:s. Treasury.and its oeiignlt5d Financiar ngeni t6 i":it,"rt" li erlttronic funds withdrawat (direct de
<br />fig?"1",*,1?l,Xi[?ilX*llHif: 3::^",,l1tjlgi:*:.J,,:rlil1.tfp"'_lion-'ott**e Er;?iTetiqi'iiilj#",litqes owed on this return, and therinancial institution to debit the entry to this acCouni il;;;;i;;p;fi;;i,iffi""i;#?#i:'#ii.'6:ir".,::';,yHfir""[Trui,nl'"i llb[Sottlr'&", ""3ji'-,13i"? ij,rf:..S:]ifl::ll^:l? l?ff:,"f:l',::"^ll^g:11 i3!9 t,th"iir;il; rf;i; iiiTii,iiiliiji.i""i"al;i#;;3"t.li"ni1i t " erectronicrater tnan 2 business days prior to the payment (settlement) datepayment of taxes to receive confidential ihformaiion necessarv tcPdyrrrer rt ur taxes ro recelve conTloentlal lnlormatlon necessary to answer inquiries and resolve issues related to the payment- I havJ selected apersonal identification number (PlN) as my signature for the el'ectronii retur,linJ, if applicable, the consent to electronic funds withdrawal.
<br />PIN: check one box
<br />IXI tauthorize
<br />only
<br />KOONCE
<br />ER0 firm name
<br />to enter my PIN 54820
<br />Enler five numbers, but
<br />do nol enter all zeros
<br />as my signature on the lax year 2o21 electronically filed return. lf I have indicated within this return that a copy of the return is being filedwith a state agency(ies) regulating charities as pad of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my plN
<br />on the return's disclosure consent screen.
<br />f l ns an officer or person subject to tax with respect to the entity, I will enter my PIN as my signature on the tax year 2o2l electronicaily filedreturn lf I have indicated within plsJqyrf\t a copy of the return is being filed with a state agency(ies) regutating charities as part of theIRS Fed/state program, r wilr ev(er ryffi ont tn" rq,urt's discrosure consent screen
<br />.- 6- lda:.
<br />ERO's EFIN/PlN. Enter your six.digit electronicvfiling identification
<br />number (EFIN) followed by your five.digit self,selected plN 5562525482L
<br />Do not enter all zeros
<br />I certify that the above numeric entry is my PlN, which is my signature on the 2021 electronically filed return indicated above. I confirm that I amsubmittingthisreturninaccordancewiththerequirementsof Pub.4l63,Modernizede.File(MeF)lnformationforAuthorizedlRs 6-;/sprovidersforBusiness Returns.
<br />ER0's signature )Date )
<br />MustRetainttris rffi
<br />Do Not Submit This Form to the tRS Untess Requested To Do SoLHAForPrivacyactandPaperworkReductionActNotice,seeinstruction"'-@
<br />102521 01-11-22
<br />PY-- :
<br />DocuSign Envelope ID: 3B3ED7CA-61F5-4E47-87CD-95256B532A12
|