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Federal Free Printable Form 12339-C (Rev. 8-2017) for 2019 Federal Advisory Committee on Tax Exempt and Government Entities - Membership Application

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Advisory Committee on Tax Exempt and Government Entities - Membership Application
Form 12339-C (Rev. 8-2017)

Department of the Treasury - Internal Revenue Service Form 12339-C (August 2017) OMB Number 1545-1791 Advisory Committee on Tax Exempt and Government Entities - Membership Application Complete all five parts of this application and return it no later than close of business of the date specified in the Federal Register Notice. See irs.gov for additional information. NOTE: Incomplete applications will not be processed. You may e-mail your application to [email protected] or FAX your application to (888) 269-7419. PART I – Applicant Information (Some of the information requested in Part I is required to perform an FBI background check) First name Middle name Last name Home street address Home telephone number City State Business name Job title ZIP code Business address City Business telephone number State Business FAX number ZIP code Business email address Which vacancy listed on the Federal Register Notice are you applying for Employee Plans Exempt Organizations Indian Tribal Governments Tax Exempt Bonds Other (specify) PART II - Desired Skills and Qualifications Attach a two page maximum statement, including recent examples, addressing your specific skills and qualifications as they relate to: ● Experience with TE/GE programs: examinations, determinations, voluntary compliance, communications, etc. ● Experience in business management and improvement. ● Experience in administration or data mining. ● Experience establishing successful strategic partnerships. ● Ability to examine issues from a "macro" viewpoint, and to effectively communicate your views and recommendations about these issues. PART III - Applicant Resume Attach a copy of your resume, including prior Treasury or IRS employment. State positions, titles, and dates of employment. In addition, list any professional credentials, membership in professional organizations and local liaison activities with IRS. Catalog Number 58763Y www.irs.gov Form 12339-C (Rev. 8-2017) PART IV - Other IRS Councils/Committees Have you ever been a member of the Internal Revenue Service Advisory Council (formerly known as Commissioner's Advisory Group), Art Advisory Panel, Electronic Tax Administration Advisory Committee, Tax Exempt & Government Entities Advisory Committee or Information Reporting Program Advisory Committee? If so, please include name of the councils/committees and dates of membership. Council/Committee name Dates of membership PART V - Applicant Acknowledgement I certify that to the best of my knowledge and belief, all of my statements are true, correct, complete and made in good faith. Upon request, I agree to submit a Tax Check Waiver Form. Applicant signature Date signed Privacy Act Statement The Privacy Act of 1974 requires that when we ask you for information about yourself, we state our legal right to do so, tell you why we are asking for it, and how it will be used. We must also tell you what could happen if we do not receive it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for the information is Public Law 92-463 and Executive Order (E.O.) 9397. We are asking for the information in order to perform Federal income tax, FBI, and practitioner checks as required of all members and applicants to the Advisory Council/Committee. Supplying the information is voluntary and not directly required by law, but facilitates the processing of your application for membership in the IRS Advisory Council/Committee. Requesting your social security number, which is solicited under authority of E.O. 9397, is also voluntary and no right, benefit, or privilege provided by law will be denied as a result of refusal to disclose it. However, not providing all or any part of the information may limit consideration of your application. Paperwork Reduction Act Notice Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws and to allow us to figure and collect the right amount of tax. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103.The time needed to complete and file this form will vary depending on individual circumstances. The estimated average time is shown below. The estimated burden for all other taxpayers who file this form is approved under OMB control number 1545-1791. Preparing, copying, assembling, and sending the form to the IRS …………………….. 10 mins. If you have comments concerning the accuracy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to: Internal Revenue Service, Tax Exempt and Government Entities, SE:T:CL/NCA 676, 1111 Constitution Avenue, NW, Washington DC 20224. Do not send the form to this address. Instead, see the return address on the form. Catalog Number 58763Y www.irs.gov Form 12339-C (Rev. 8-2017)
Extracted from PDF file 2018-federal-form-12339-c.pdf, last modified July 2017

More about the Federal Form 12339-C Other TY 2018

We last updated the Advisory Committee on Tax Exempt and Government Entities - Membership Application in February 2019, so this is the latest version of Form 12339-C, fully updated for tax year 2018. You can download or print current or past-year PDFs of Form 12339-C directly from TaxFormFinder. You can print other Federal tax forms here.


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Form Sources:

The Internal Revenue Service usually releases income tax forms for the current tax year between October and January, although changes to some forms can come even later. We last updated Federal Form 12339-C from the Internal Revenue Service in February 2019.

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Historical Past-Year Versions of Federal Form 12339-C

We have a total of six past-year versions of Form 12339-C in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2018 Form 12339-C

Form 12339-C (Rev. 8-2017)

2017 Form 12339-C

Form 12339-C (Rev. 8-2017)

2016 Form 12339-C

Form 12339-C (Rev. 8-2016)

Advisory Committee on Tax Exempt and Government Entities - Membership Application 2015 Form 12339-C

Form 12339-C (Rev. 8-2015)

Advisory Committee on Tax Exempt and Government Entities - Membership Application 2012 Form 12339-C

Form 12339-C (Rev. 9-2012)

Advisory Committee on Tax Exempt and Government Entities - Membership Application 2011 Form 12339-C

Form 12339-C (10-2011)


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