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DEPARTMENT OF CULTURAL AFFAIRS OF THE CITY OF NEW YORK 830 FIFTH AVENUE, NEW YORK, NEW YORK 10021
23. Fiscal Information:
a. If you have an audited financial statement prepared by either a Certified Public Accountant or an independent accountant for your most recent complete year of operation, please submit a copy. pp. 2b, 2c, 2d
b. Is your organization required to file Form BSW 497 (long or short) or G750 497 with the Charities Registration Section ___ Yes __X__ No. We will begin filing at the end of this fiscal year. Our registration # is 47433. If Yes, submit a complete copy of your latest one.
Please attach one of the following:
_X_ A copy of the letter from the U.S. Treasury Department granting federal tax exemption under section 501 (c)(3) of the U.S. Internal Revenue Code.
__ A copy of the Charter issued by the Board of Regents of the State of New York under section 216 of the Education Law.
__ A copy of form DSW 189 or BSW 460 or G750 460 from the Office of Charities Registration, New York State.

24. Certification and Release:
The undersigned certifies that he or she (1) is an authorized signator of the applicant with authority to obligate it; (2) has knowledge of the information presented herein; (3) has read the guidelines of the Department of Cultural Affairs of the City of New York, incorporated herein by reference, and that this applicant complies with and is made subject to said guidelines; (4) on behalf of the applicant releases the Department of Cultural Affairs of the City of New York, their employees and agents with respect to damages to property or materials submitted in connection herewith.

Jaime Davidovich            Leandra Strobing
(executive Director-type)   *(Program Director-type)

152 Wooster St.             133 Chrystie St.
(Address)                   (Address)

New York, N.Y. 10012         New York, N.Y. 10002
(City and Zip)               (City and Zip)

212-254-4978                 212-431-4687
(Telephone)                  (Telephone)

Jaime Davidovich             Leandra Strobing
(Signature)                  (Signature)

*Person to be contacted regarding this application.

DCA 78-79 PAGE V