Form 1120-POL U.S. Income Tax Return for Certain Political Organizatio

U.S. Income Tax Return
for Certain Political Organizations

1120-POL

Form
Department of the Treasury
Internal Revenue Service

For calendar year 2009 or other tax year beginning
Check the box if this is a section 501(c) organization .
Name of organization

Check if:
Final return
Name change

Income
Deductions

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2
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18

Tax

, 2009, and ending
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D /27
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19
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23

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, 20
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Candidates for U.S. Congress Only

City or town, state, and ZIP code

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17c
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23d
24
25
At any time during the 2009 calendar year, did the organization have an interest in or a signature or
other authority over a financial account (such as a bank account, securities account, or other financial
account) in a foreign country? (see instructions) . . . . . . . . . . . . . . . . .

Yes

No

2

If “Yes,” enter the name of the foreign country 䊳
During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor
to, a foreign trust? If “Yes,” the organization may have to file Form 3520 . . . . . . . . . .

Yes

No

3
4
5a
c

Enter the amount of tax-exempt interest received or accrued during the tax year . . . 䊳
Date organization formed 䊳
b Enter name of candidate 䊳
The books are in care of 䊳
d Telephone No. 䊳
The books are located at 䊳

1

Additional
Information

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If this is a principal campaign committee, and it is the
ONLY political committee, check here .
.
.
.
If this is a principal campaign committee, but is NOT
the only political committee, check here and attach a
copy of designation (See instructions on page 2.) .

Taxable income. Subtract line 18 from line 17c. (If line 19 is zero or less, see the instructions.) . .
Income tax. (see instructions) . . . . . . . . . . . . . . . . . . . . . .
Tax credits. (Attach the applicable credit forms.) (see instructions) . . . . . . . . . . .
Total tax. Subtract line 21 from line 20 . . . . . . . . . . . . . . . . . . . .
23a
Payments: a Tax deposited with Form 7004 . . . . . . . .
b Credit for tax paid on undistributed capital gains (attach Form 2439)
23b
c Credit for federal tax on fuels (attach Form 4136) . . .
23c
d Total payments. Add lines 23a through 23c . . . . . . . . . . . . .
Tax due. Subtract line 23d from line 22. See instructions on page 4 for depository method of payment
Overpayment. Subtract line 22 from line 23d
. . . . . . . . . . . . . . . . .

24
25

.

Employer identification number

Dividends (attach schedule) . . . . . . . . . . . . . . . . . . . . . .
Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . .
Gross royalties . . . . . . . . . . . . . . . . . . . . . . . . . .
Capital gain net income (attach Schedule D (Form 1120)) . . . . . . . . . . . . .
Net gain or (loss) from Form 4797, Part II, line 17 (attach Form 4797) . . . . . . . . .
Other income and nonexempt function expenditures (see instructions) . . . . . . . . .
Total income. Add lines 1 through 7 . . . . . . . . . . . . . . . . . . .
Salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . .
Repairs and maintenance . . . . . . . . . . . . . . . . . . . . . . .
Rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Taxes and licenses . . . . . . . . . . . . . . . . . . . . . . . . .
Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Depreciation (attach Form 4562) . . . . . . . . . . . . . . . . . . . . .
Other deductions (attach schedule) . . . . . . . . . . . . . . . . . . . .
Total deductions. Add lines 9 through 15
. . . . . . . . . . . . . . . . .
Taxable income before specific deduction of $100 (see instructions). Section 501(c) organizations show:
Amount of net investment income . . . . . . . . . . . . . 䊳
Aggregate amount expended for an exempt function (attach schedule) . . 䊳
Specific deduction of $100 (not allowed for newsletter funds defined under section 527(g)) . .

a
b

Sign
Here

2009

Number, street, and room or suite no. (If a P.O. box, see page 5 of instructions.)

Address change
Amended return

OMB No. 1545-0129

$

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

䊳

Paid
Preparer’s
Use Only

Signature of officer
Preparer’s
signature

䊳

Firm’s name (or
yours if self-employed),
address, and ZIP code

Date

䊳

May the IRS discuss this return
with the preparer shown below
(see page 3)?
Yes
No

Title

Date

䊳

For Privacy Act and Paperwork Reduction Act Notice, see separate instructions on page 6.

Check if
self-employed

Preparer’s SSN or PTIN

EIN
Phone no.
Cat. No. 11523K

Form 1120-POL (2009)