You are on page 1of 11

Form Exempt Organization Business Income Tax Return OMB No 1545-0687

(and proxy tax under section 6033(e))


Fer calendar year 2013 or other tax year beginning , and ending
2013
Department of the Treasury D Information about Form 990-T and its instructions is available at WW "5 gov/formggm.
0 en to Public inspection for
Internal Revenue SerVIce D Do not enter SSN numbers on this form as it may be made public it your organization is a 501(c)(3). 5 1(cx3) Organizations Only
71:] Check box It Name 01 organization ( 1:] Check box 11 name changed and see Instructions.) ogpglggfgggffsg um
address changed CHURCH OF so I ENTOLOGY FLAG Instructions)
B Exempt under section Print SERVICE ORGANI ZATION , INC . 59-2143308
501(C )( 3 ) r Number, street, and room or sude no. It a P.0. box, see instructions. E,gg;::;?uggj'::,ss WW ng
[34mm [:|220(e) ""9 2 1 0 s. FORT HARRI SON AVE.
[:14OBA D530(a) City or town, state or provmce, country, and ZIP or foreign postal code
1:1529(a) CLEARWATER, FL 337565109 721110
Book value of all assets F Group exemption number (See instructions.) P
at end of year
2 l 8 1 5 4 3 1 9 . G Check organization type P LXJ 501(c) corporation LJ 501(c) trust |_| 401(a) trust L] Other trust
H Describe the organizations primary unrelated busmess actIVIty. b SEE STATEMENT 1
l During the tax year, was the corporation a subSIdIary in an affiliated group or a parent-subsndlary controlled group? D Ll Yes No
If 'Yes, enter the name and identifying number of the parent corporation. P
J The books are in care of P GLEN STILO , SECRETARY Telephone number F 727467-5000
Wart l | Unrelated Trade or Business Income (A) Income (B) Expenses (0) Ne!
1a Gross receipts or sales 154 , 927 . E
b Less returns and allowances c Balance b 1c 154 , 927 . l
2 Cost of goods sold (Schedule A, Ilne 7) 2 46 , 440 . i
3 Gross profit. Subtract line 2 from line 1c 3 108 , 487 . 1O8 , 487 .
4a Capltal galn net Income (attach Form 8949 and Schedule D) 4a
b Net galn (loss) (Form 4797, Part II, line 17) (attach Form 4797) 4b "
c Capital loss deduction for trusts 4c
5 Income (loss) from partnerships and S corporations (attach statement) 5
6 Rent income (Schedule C) 6
7 Unrelated debt-financed income (Schedule E) 7
8 Interest, annurties, royalties, and rents from controlled organlzatlons (Sch. F) 8
9 Investment income of a section 501(c)(7), (9), or (17) organization (Schedule G) 9
10 Explaited exempt activ1ty income (Schedule |) 10
11 Advertismg income (Schedule J) 11
12 Other Income (See instructions; attach schedule.) 12 ~
13 Total. Combine llnesathroughlz 13 108 , 487 . 108 , 487 .
I Part II I Deductions Not Taken Elsewhere (See instnrctions for limitations on deductions.)
(Except for contributions, deductions must be directly connected With the unrelated busmess income.)
14
Compensation of officers, directors, and trustees (Schedule K) 14
15
Salaries and wages 15 l7 , 928 .
Repairs and maintenance
16 _, 16 3 , 920 .
17
Bad debts __ \ 17
18
Interest (attach schedule) 3: \ klli, 18
19
Taxes and licenses 7 ' ' J \(Q 19 4 , 56 0 .
20
Charitable contributions (See Instructionstor limitation rules.) Mr, q ll. 20
21
DepreCIation (attach Form 4562) 2' w L 21). 18 , l 1 0 . __
22
Less depreciation claimed on Schedule A and elsewhere on return ._\ __,,.4 :22a '1 22b 18 , l10 .
23
Depletion \ y \1 1 , 23
(131%in
330
17102
1; 24 Contributions to deferred compensation plans , 1; "J HT 24
25
Employee benefit programs 25
26
Excess exempt expenses (Schedule I) 26
27
Excess readership costs (Schedule J) _ 27
28
Other deductions (attach schedule) SEE STATEMENT 3 28 8l , 778 .
29
Total deductions. Add lines 14 through 28 29 126 , 296 .
30
Unrelated busmess taxable income before net operatmg loss deduction. Subtract line 29 from lIne 13 30 <1 7 , 8 0 9 . >
31
Net operating loss deduction (limtted to the amount on line 30) 31
32
Unrelated busmess taxable Income before specific deduction. Subtract Ime 31 from line 30 32 <1 7 , 8 0 9 . >
33
Specific deduction (Generally $1,000, but see instructlons for exceptions.) , _ _ 33 l , 000 .
34
Unrelated business taxable income. Subtract lIne 331roml1ne 32.ll|1ne 33 is greater than line 32, enter the smaller of zero 0r
line32 34 <17,809.>
m3 LHA For Paperwork Reduction Act Notice, see instructions. Form 990-T (2013)
CHURCH OF SCIENTOLOGY FLAG
Form990-Tl2013) SERVICE ORGANIZATION, INC. 592143308 Page 2
I Part III | Tax Computation
\ 35 Organizations Taxable as Corporations. See Instructions for tax computation.
Controlled group members (sections 1561 and 1563) check here > E] See instructions and:
a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
(1) |$ I (2) Is I (3) Is I
b Enter organization's share or. (1) Additional 5% tax (not more than $11,750) |$ |
(2) Additional 3% tax (not more than $100,000) |$ I
c Income tax on the amount on line 34 35c 0 .
36 Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on the amount on line 34 from:
[:1 Tax rate schedule or Cl Schedule D (Form 1041) b 36
37 Proxy tax. See instructions P 37
38 Alternative minimum tax 38
39 Total. Add linesgz and 38 to line 35c or 36, whichever applies 39 0 .
n IvlJTax and Payments
40a Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) 40a
b Other credits (see instructions) 40b
c General busmess credit Attach Form 3800 400
11 Credit tor prior year minimum tax (attach Form 8801 or 8827) 40d __.__
e Total credits. Add lines 40a through 40d 40c
41 Subtract line 40e from line 39 41 0 .
42 Other taxes Check it from: [:1 Form 4255 |:l Form 8611 [:1 Form 8697 |:I Form 8866 [:1 Other (attach schedule) 42
43 Total tax. Add lines 41 and 42 43 0 .
44 a Payments: A 2012 overpayment credited to 2013 44a 5 , 000 .
b 2013 estimated tax payments 44b 5 , 229 .
0Tax depOSited With Form 8868 44c
0Foreign organizations: Tax paid or Withheld at source (see instructions) 44d
eBackup Withholding (see instructions) 44a
1Credit for small employer health insurance premiums (Attach Form 8941) 441
9Other credits and payments: [:1 Form 2439
El Form 4136 C] Other Total p 44g
45 Total payments Add lines 44a through 44g 45 l0 , 229 .
46 Estimated tax penalty (see instructions). Check 11 Form 2220 is attached b E] 46
47 Tax due. ll line 45 is less than the total of lines 43 and 46, enter amount owed b 47
48 Overpayment. ll line 45 is larger than the total of lines 43 and 46, enter amount overpaid _ b 48 10 , 229 .
49 Enter the amount of line 48 you want Credited to 2014 estimated tax b l 0 , 2 2 9 .I Relunded b 49 0 .
[part v I Statements Regarding Certain Activities and Other Information (see Instmctlons)
1 At any time during the 2013 calendar year, did the organization have an interest in or a Signature or other authority over a financial account (bank, Yes No
securities, or other) In a loreign country? If YES, the organization may have to file Form TD F 90-221, Report 01 Foreign Bank and Financ1al
Accounts. ll YES, enter the name of the foreign country here > UNITED KINGDOM AND AUSTRALIA X
2 Wt? :22 8:533:08: $3338.?2312':In?233?.I%2%$321"25%! " X
3 Enter the amoun_t ol tax-exempt interes_t received or accrued during the tax year > $ 0 . I
Schedule A - Cost of Goods Sold. Enter method of inventory valuation b ALLOCATED
1 Inventory at beginning ol year 1 0 o 6 Inventory at end of year 6 0 .
2 Purchases 2 4 6 , 44 0 . 7 Cost 01 goods sold. Subtract line 6 "_
3 Cost ol labor 3 from line 5. Enter here and in Part I, line 2 AJ 46 , 440 .
4 a Additional section 263A costs (an schedule) 4a 8 Do the rules 01 section 263A (With respect to Yes No
b Other costs (attach schedule) 4b property produced or acqu1red for C ___ ___l
5 Tota|.Add lines 1 througle 5 46 , 440 . the organization? A 0.5 A w X
S. were?.amusemeezaizeeeemesses:gammadare: $91. 9. 1 a
ign <
Here lam/m. 5 O 80
Date ( mstrucuons)? [X] Yes E] No
Print/Type preparers name
Preparer's signature 0 D Date Check I il PTIN i
Paid WI LLIAM selt- employed
Preparer WILLIAM D. ESENSTEN ESENSTEN 11/17/14 P00535334
use only Firm's name DNSBN LLP Firm's EIN b 95-2399533
9454 WILSHIRE BLVD. , 4TH FLOOR
Flrm'SaddreSS b BEVERLY HILLS, CA 90212-2907 Phoneno. (310)2732501
323711 12-12-13 Form 990-T(2o13)
CHURCH OF SCIENTOLOGY FLAG
Form 990-T (2013) SERVICE ORGANIZATION, INC . 59 2143308 Page 3
Schedule C - Rent lncomejFrom Real Property and Personal Property Leased With Real Property)(898 INSUUCIIOHS)
(
1. Description of property

(1)
(2)
(3)
(4)
2, Rent received or accrued
a From personal property (it the percentage of I) From real and personal property (it the percentage 3(a)Deductions directly connected With the income in
( ) rent for personal property is more than ( of rent for personal property exceeds 50% or I( celumns 2(a) and 2(bHaHBCh scnwum)
10% but not more than 50%) the rent is based on prot or income)
(1)
C2)
(3)
45L
Total 0 . Total 0 .
(c) Total income. Add totals of columns 2(a) and 2(b). Enter (b) Tm deductwns-
Enter here and on page 1,
here and on page 1, Part I, line 6, column (A) p 0 . Part I, line a, column (a) p 0 .
Schedule E - Unrelated Bebt-Financed Income (see instructions)
3, Deductions directly connected With or allocable
2_ Gross Income from to debt-nanced property
or allocable to debt- (a) sum ght line depreCIation ( b(anach
1. Description of debt _ nanced property financed property (anach schedule) )Other schedum
deductions

(1)
(2)
(3)
(4)
4 _ Amount 0 i average acqursition 5 _ A verage a d luste d b a5is 6 _ c olumn 4 diVided 7 . G ross income 8 , Alloca bl e d ed uctions
debt on or allocable to debt-nanced of or allocable to by column 5 reportable (column (column 6 x total 01 columns
property (attach schedule) debtnanced property 2 x column 5) 3(a) and 3(1)
(attach schedule)

(1) %
42) %
L3) %
(4) 0/o
Enter here and on page 1, Enter here and on page 1.
Pan I, line 7, column (A) Pan I, line 7, column (B)
Totals b 0. 0 .
Total dividends-received deductions Included in column 8 b 0 .
Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see Instructlons)
Exempt Controlled Organizations
1. Name of controlled organization 2. 3. 4. 5. Pan of column 4 that is 6. Deductions directly
Employer identication Net unrelated income Total of speCIed included in the controlling connected With income
number (loss) (see instructions) payments made organization's gross income in column 5

(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations
7, Taxable Income 8_ Net unrelated income (loss) 9, Total of specied payments 10, Pan of column 9 that is included 11, Deductions directly connected
(see instructions) made in the controlling organization's With income in column 10
gross income

(1)
(2)
(3)
(4)
Add columns 5 and 10 Add columns 6 and 11
Enter here and on page 1, Part I. Enter here and on page 1, Pan I.
into 8. column (A) line 8, column (B)
Totals . . . . b 0 . 0 .
323721 12-12-13 Form SSO-T (2013)
CHURCH OF SCIENTOLOGY FLAG
Form 990-T(2013) SERVICE ORGANIZATION, INC. 592143308 Page 4
Schedule G - Investment Income of a Section 501(c)(7), (9), or (17) Organization
\ (see Instmctlons)
3. Deductions 4. Sel'aSIdBS 5. Total deductlons
1, Descnpuon 01 Income 2_ Amount 01 Income dIrectIy connected and set-aSIdes
(attach schedule) (attach schedule) (col 3 plus col 4)
(1)
(2)
(3)
(4)
Enter here and on page 1. Enter here and on page 1,
Part I. ma 9. column (A) Pan l, km 9. column (B)

Totals p 0 , 0 ,
Schedule I - Exploited Exempt Activity Income, Other Than Advertising Income
(see InstructIons)
4. Net Income (loss)
2. Gross dlrgu$x:$ed from unrelated trade or 5. Gross Income 6 Expenses ngizzzsgip
1. Description ol unrelated busrness mm roducuon ousmess (column 2 from activity that atibumbla 0 6 minus column 5
exploited actIVIty Income from of :melated mInus column 3) If a Is not unrelated column 5 but not mow man
trade or bustness busmess Income gain, crogggefols 5 busmess Income column 4)

(1)
(2)
(3)
(4)
Enter here and on Enter here and on Enter here and
page 1. Part 1. page 1, Part I. on page 1,
lIne 10, col (A) lIne 10. col (B) 5,x ~ , , 334;;
, Part II, lIne 26
Totals b 0 . 0 . 0 .
Schedule J - Advertising Income (see ll'tStrUCthllS)
I part | | Income From PerIodIcaIs Reported on a ConsoIIdated BaSIs

2. Gross 4. Advemsmg gain 7. Excess readership


1 advmlsm 3. DIrect or (loss) (col 2 mmus 5. CIrculatIon 6. Readership costs (column 6 mInus
- Name 0' DHIOdlca' mme g advertIsrng costs col 3) lf a 93m. compute Income costs column 5, but not more
cols 5 through 7 than column 4)

<1)
(2)
(3)
(4)

Tota|s(carrylo Part II, km (5)) > _ 0 . 0 . 0 .


l part || | Income From Periodicals Reported on a Separate Basis (For each perlodlcal lIsted In Part II, fIlI In
columns 2 through 7 on a lIne-by-llne baSIS)

2. Gross 4. Advemsmg 9am 7. Excess readershlp


advemsm 3. DIrect or (loss) (col 2 rnInus 5. CIrcuIatIon 6. Readershlp costs (column 6 mInus
1- Name 0' Dlodlcal Income 9 advertising costs col 3) II a gain, compute Income costs column 5. but not more
col: 5 through 7 than column 4)

(1)
(2)
(3)
(4)
Totals from Partl O . 0 . 0 .
Enter here and on Enter here and on Enter here and
page 1. Part I. page 1. Part I. on page 1.
line 11. cal (A). um 11. col (B) Part II. lIne 27
Totals, Part II (lInes 1-5) F 0 . 0 . 0 .
Schedule K - Compensation of OfTicers, Directors, and Trustees (see Instructions)
4. Compensation annbutable
1 . Name 2' ne m9busmess
downed to to unrelated busrness

Total. Enter here and on 1 Panl line 14


Form 990-T (2013)
323731
12-1243
CHURCH OF SCIENTOLOGY FLAG SERVICE ORGAN 592143308

FORM 990-T DESCRIPTION OF ORGANIZATION'S PRIMARY UNRELATED STATEMENT 1


BUSINESS ACTIVITY

LIMITED USE OF FACILITIES FOR MEETINGS THAT MAY NOT BE SUBSTANTIALLY


RELATED TO THEIR TAX EXEMPT PURPOSES.

TO FORM 990-T, PAGE 1

FOOTNOTES STATEMENT 2

ELECTION TO WAIVE THE NET OPERATING LOSS CARRYBACK PERIOD

CHURCH OF SCIENTOLOGY FLAG SERVICE ORGANIZATION INC.


ELECTS, PURSUANT TO SEC. 172(B)(3) OF THE INTERNAL REVENUE
CODE, TO RELINGQUISH THE ENTIRE CARRYBACK PERIOD WITH
RESPECT TO THE NET OPERATING LOSS INCURRED FOR THE TAX YEAR
ENDED DECEMBER 31, 2013, AND WILL HAVE SUCH LOSS AVAILABLE
FOR CARRYFORWARD ONLY.

STATEMENT(S) l, 2
CHURCH OF SCIENTOLOGY FLAG SERVICE ORGAN 59-2143308

FORM 990-T OTHER DEDUCTIONS STATEMENT 3

DESCRIPTION AMOUNT

CLEANING & LAUNDRY 3,327.


EQUIPMENT RENTAL 2,601.
PROPERTY INSURANCE 8,457.
STAFF WELFARE 31,067.
TRANSPORTATION EXPENSE 2,571.
UTILITIES EXPENSE 7,161.
WORKERS COMPENSATION INSURANCE 6,366.
SUPPLIES FOR USE OF FACILITIES 7,992.
EVENTS EXPENSE 7,068.
OFFICE EXPENSE 32.
ACCOUNTING FEES 5,136.

TOTAL TO FORM 990-T, PAGE 1, LINE 28 81,778.

STATEMENT(S) 3
I

/
5~ . 31,29,0.3627.09. 23,0.312. 34,13.
469.
482.397. 50,703.
14,1,127965.519.27. 50,12
708.
14,1,97619.85.27,
:146,512718.17,9.0L6, 18694,9. 86. 5
iii 4 713,8106.1L,8709,8090. 1 60,3150,8.15,s,2153,4e.4a.
an A

g?
57,50.041.

Excl
Depreciation
Expense

41X
4-
~,M
04"A93
~K
W
EndidLiucdrjinuoteisniontnSetndgNECost
SectUnaBus
ReCurBegiYear
179
BaSI
In
For Basns
0r
De%
Basus
A179
Sec
xpense
c pud0rmuecultiaoetidnon newee
00:)

Dat

OTHER SANDCASFEQUI<ITNETS.3
LPE.- FOSEQUIITNCE-OSLPA. FURNIEa
QTUUREIP-MENTS .1161,
'965,1
90
TOTHER
167,90-OTAL
0.47127.745.27.37. BUILDINGS 41'49651
,'PG
1B59oT9U50me1I7.Lt6Dl7.,LI6N0936G0,645 6. QCUHIPNMEREYNT HEUIP.
MAE& FFORT
ITNES '91
TPG
M90-OTAL
ACHINETRY EE
QUIPMENT 990-1
TPG
OTAL-T BUILDINGS pBLDG.
IaM's-f
P1R9OV3E. 07/11631588.
31.11311?
81.SA0ND1/C5A9S0T2LE
6
{$312601
111017
07/7.00
SL
FCTR.
I0T1/NE9S9l F1
11
07.00
43,SL
16
70-
43.FCTR,
/I0T1N7/7E016.S115- 13
07/57,SD
16
5.00
EV0E1/0NT41.1S 14
C0E16
5.O1
1SL
1,V7M0.
/EP019.
-NU01T/E0RS19.01 *23,15
F07/E5.00
16
UsL
&
QRUNI0PTM11/UER0N2?T2S 16
C07/5.00
16
O10,5L
M0.
10,P0U1/T9E09R30.230. MML7
4452135g
7a
07/B39.FORT
HSL
UAIRL0DI1/SN0OG0N09 07/79
7.00
20003
70CTR.
FH1/IATRN0IES9OSN
A33
Ammfed
DeMetLife
scrhipodtion 105
B07/FORT
34,39.HUSL
MM16
AILRD0I1/SN30OG197.N0
DAND
2013
AREPORT
EMPORECTIAZTION 990-1
FORM
PAGE
990TT . .1_,42_4.
320m (D)
0Asset
diSalI5Bonus.
CGO
DeR"-oe0TC,
Zone svm1uposed
d-tme1-avucl3uage,zractnlioanln,
73R?5%.1.5. .

Deprpremuaonanon
DeExcl
Expense %
NuTW

SUnaeudcnueLmeodcnulmsFYo1eorn7al9mnr dASec
CBaysRBus
Cunenl
Bewnnmg
Endmg 0r
Cost
ENo
DeBaSI
179
% cxpense
pudrmuecltuaioSetndlon
UO:>

DI

32117
10,1,20.St.
S43A7N1,/D034,3C1A.04LS/,'1I0L3E4130.3, 03 .

pBLDG.
IoMmP-R1O9 V3E. 2002
IMPROVE.
BLDG. 026.'57981
BTpg
,468U90-OTAL
427IL4.0D,62I7N01T.,G261S. '0921
T99
6.5790-OTAL8,469427.041,62701,.261 . BUILDINGS 2,2,0H2117
20.56FORT
HBs0
4.7UA40,28,/RIL60-D741I.S028N/,O6G4067.2Na16,27. BUILDING 033,,7'831
97B2TPG
,U82,3790-9OTALI87L.23D,37I8N97.2T9G,37S. '9o33,1
T,PG
7.8390T
OTAL
72,382,79-e7.z3,37897.29,379. '990-1
TOTALT 18,172,3521papa
GRAND
PG 2973418065982.10.1032.
01a
M'39.4SL
v,21n92s6,7uous9wM06a0.4Lnl,78s790-4r1,.m9 1. m
29,654,20
0.
39.07/8L
MM17
SA0N91/D02C32.A037.0S2TLE 24
39.07/SBSL
1,MMl
0.
25.
AUNIDL90CDA1/0IS42.NT70LG0E3
Acqifed
AW:
DeLIfe
Metscrhlpoduon
DREPORT
A2013
AND
EMPORETCIZATION 990-1
9PAGE
FORM90TT ._1W4~-, 8281 1 GO
-RCdl0A'eo5TC,
SalI(0)
DeBonus.
Zone vms-dusset0tmepuca1vl-osz1age,rat3CiloIaenld.
OMB No 1545-0172
Fm. Depreciation and Amortization 990-T
(Including Information on Listed Property) Attachment
Department of the Treasury
lntemal Revenue Serv-ce (99) > See separate instructions. b Attach to your tax return. Sequence No 179
Name(5) Show" 0" return Busmess or actrvrty to which this form relates Identrfyrng number
CHURCH OF SC IENTOLOGY FLAG
SERVICE ORGANIZATION, INC. FORM 990T PAGE 1 592143308
I Part u Election To Expense Certain Property Under Section 179 Note: If you have any lrsted property, complete Part Vbefore you complete Part I.
1 Maxrmum amount (see Instructions) 1 500 I 000 o
2 Total cost of sectIon 179 property placed In servrce (see InstructIons) 2
3 Threshold cost of sectIon 179 property before reductIon In IImItatIon 3 2 I 000 I o00 -
4 ReductIon In IImItatIon. Subtract lIne 3 from lIne 2 It zero or less, enter 0- 4
5 Dollar IImItatIon for tax year Subtract lIne 4 from me 1 ll zero or less, enter -0- I1 mamed tIng separately. see InstructIons _ _ 5
6 (a) Descrlptron of property (b) Cost (busrness use only) (c) Elected cost I

l
I

7 LIsted property Enter the amount from lIne 29 I 7 ____ __ ~_ ____ ~___I
8 Total elected cost of sectIon 179 property Add amounts In column (0), IInes 6 and 7 8
9 TentatIve deductlon Enter the smaller of lIne 5 or lIne 8 _ 9
10 Carryover of dIsallowed deductIon from lIne 13 of your 2012 Form 4562 10
11 Busmess Income lImItatIon Enter the smaller of busmess Income (not less than zero) or lIne 5 11
12 SectIon 179 expense deductron. Add lInes 9 and 10, but do not enter more than lIne 11 12
13 Carryover of dIsallowed deductIon to 2014. Add lInes 9 and 10, less lIne 12 >I 13 I v " ,, I. I q, em}; !)
Note: Do not use Part II or Part III below for lIsted property. Instead, use Part V.
[Part II I Special Depreciation Allowance and Other Depreciation (Do not Include |Isted property.)
14 Specral deprecIatIon allowance for quaIIerd property (other than |Isted property) placed In servrce dunng
the tax year 14
15 Property subject to sectIon 168(f)(1) electron 15
16 Other depreCIatIon (IncludInq ACRS) 16 l3 .
MACRS Depreciation (Do not Include |Isted property.) (See InstructIons.)
Section A
17 MACRS deductrons for assets placed In servrce In tax years begInnIng before 2013 17 I 18 , 097 -
18 It you are electrng to group any assets placed In servrce durrng the tax year Into one or more general asset accounts, check here I:I 3 if? g y
Section B - Assets Placed in Service During 2013 Tax Year Using the General Depreciation System
(b) Month and (c) Basrs for deprecratron (d) Recovery
(a) Classrcatron of property year placed (busIness/investment use perlod (a) ConventIon (1) Method (9) Deprecratlon deductlon
In servrce only - see InstructIons)

S/L
MM S/L
h Resrdentlal rental property
MM S/L
39 MM S/L
i Nonresrdentral real property /
MM S/L
Section C - Assets Placed in Service During 2013 Tax Year Using the Alternative Depreciation System
20a Class lIfe S/L
b 12-year 12 yrs. S/L
c 40-year / 40 yrs. MM S/L
I Part IVI Summary (See InstructIons)
21 LIsted property. Enter amount from lIne 28 21
22 Total. Add amounts from lIne 12, lInes 14 through 17, ms 19 and 20 In column (9), and lIne 21.
Enter here and on the appropnate ms of your return. Partnershrps and S corporatIons - see instr. 22 18 , 1l0 .
23 For assets shown above and placed In servrce dunng the current year, enter the
portron of the baSIS attnbutable to sectIon 263A costs 23
3551295313 LHA For Paperwork Reduction Act Notice, see separate instructions. Form 4562 (2013)
CHURCH OF SCIENTOLOGY FLAG
Forrn4562(2013) SERVICE ORGANIZATION, INC . 592143308 page 2
I Part V I Listed Property (Include automobiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or
amusement)
Note: For any vehicle for which you are usmg the standard mileage rate or deducting lease expense, complete only 24a, 24b, columns (a)
through (c) of Section A, all of Section B, and Section C if applicable.
Section A - Depreciation and Other Information (Caution: See the Instructions for limits for passenger automobiles.)
243 Do you have evrdence to support the busrnessfinvestment use claimed? I I Yes I I No 24:, If 'Yes, 13 the ewdence wntten? CI Yes CI No
(a) [(3b) (e) (d) (e) (r) (9) (h) (i)
Type ol property ate BUS'MSSI Cost or 335" '' mam Recovery Method/ Deprecration E'eCted
(list vehicles first ) placed
sen/me in investment
use percentage other basrs (bus-nessrmvestmem
use my) period Convention deduction section
cost 179

25 SpeCIal deprecration allowance for qualified listed property placed in serv1ce during the tax year and
used more than 50% in a qualified busrness use _ 25
26 Property used more than 50% in a cualied busrness use:
%
%
%
27 Property used 50% or less in a qualied busmess use:
% s/L .
% S/L .
% S/L-
28 Add amounts in column (h), lines 25 through 27. Enter here and on line 21, page 1 28
29 Add amounts in column (i), line 26 Enter here and on line 7. page 1 I 29
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole propnetor, partner, or other 'more than 5% owner, or related person. If you provrded vehicles
to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.

(a) (b) (C) (d) (e) (f)


30 Total busmess/investment miles driven during the Vehicle Vehicle Vehicle Vehicle Vehicle Vehicle
year (do not include commuting miles)
31 Total commuting miles driven during the year
32 Total other personal (noncommuting) miles
dnven
33 Total miles driven dunng the year.
Add lines 30 through 32
34 Was the vehicle available for personal use Yes No Yes No Yes No Yes No Yes No Yes No
during offduty hours?
35 Was the vehicle used pnmanly by a more
than 5% owner or related person?
36 Is another vehicle available for personal
use?
Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to deterrnine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%
owners or related persons.
37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your Yes No
employees? _
38 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See the instmctions for vehicles used by corporate officers, directors, or 1% or more owners
39 Do you treat all use of vehicles by employees as personal use? _ _
40 Do you provrde more than five vehicles to your employees. obtain information from your employees about
the use of the vehicles, and retain the information received? _
41 Do you meet the requirements conceming qualified automobile demonstration use?
Note: If your answer to 37. 38, 39, 40, or 41 is Yes, ' do not complete Section B for the covered vehicles
I Part VI I Amortization
(a) (b) (e) (d) (e) (f)
Description of costs Dar; ammuan Amoruzable Code Amomzanun Amortization
tieglns "0" WW" penou oi percentage ' ""5 Y!
42 Amortization of costs that 2013 tax

43 Amortization of costs that began before your 2013 tax year

316252 12-19-13 Form 4562 (2013)


go (14
Form 8868 Application for Extension of Time To Fi / 7r
(Rev. January 2014)
Exempt Organization Return V4709

watment of the Treaswy > File a separate application for each return.
lMondRummwSe~be D information about Form 8868 and its instructions is at www.lrs.gov/lonn8868.
0 If you are ling for an Automatic 3-Montb Extension. complete only Part I and check this box . > El
' 'f YOU are ling for an Additional (Not Automatic) anMenth Extension. complete only Part ii (on page 2 of this form).
Do not complete Pen ll unless you have already been granted an automatic 3-month extenSIon on a prewously led Form 8868
Electronic ling (e-le). You can electronically file Farm 8868 if you need a 8-month automatic extenSion of time to le (6 months for a corporation
required to le Form 990T). or an additional (not automatic) 3-month extension of time. You can electronically le Form 8868 to request an extensiOn
of time to le any of the forms hated in Part I or Part ll with the exception of Form 8870. information Return for Transfers Associated With Certain
Personal Benet Contracts, which must be sent to the IRS in paper format (see instructions). For mere details on the electronic ling of this form,
Visn www.irs v/efile and click on e-le for Charities & Non rots
I Partl I Automatic 3-Month Extension of Time. Only submit original (no copies needed).
A corporation required to le Form 990T and requesting an automatic 6-month extension - check this box and complete
Part i only F If]
All other corporations ncluding 1120-0 lers). partnerships. REM/Cs. and trusts must use Form 7004 to request an extension of time
0 "9 "mama tax mm En filera identi n n mber
Type or Name of exempt organization or other ler. see instructions. Employer identication number (EIN) or
print CHURCH OF SCI ENTOLOGY FLAG
F". by m SERVICE ORGANI ZATION . INC . 59 2143308
do. mm, Number. street, and room or surte no. it a P.O. box. see instructions. Some! security number (SSN)
my
return See CjO NSBN LLP - 9454 WILSHIRE BLVD 4TH FLR
instructions City. town Or post ofce. state. and ZIP code. For a foreign address. see Instructions
BEVERLY HILLS, CA 90212

Enter the Return code for the return that this application is for (file a separate application tor each return) a

Application Return Application

T
Form

4720

Form 990-T
T
GLEN STILO , SECRETARY
0 The books are in the care of > 21 0 S . FORT HARRISON AVE . - CLEARWATER , FL 3 3 7 5 6
Telephone No. > Fax No b
0 If the organization does not have an ofce or place of business in the United States. check this box _ D [:l
0 If this is for a Group Return. enter the organization's four digit Group Exemption Number (GEN) It this is for the whole group, check this
box . If it is far art of the rou check this box and attach a list With the names and EINs of all members the extension is for.
1 | request an automatic 3-month (6 months for a corporation reqwred to le Form 9901) extension of time until
NOVEMBER 1 5 . 2 0 1 4 . to le the exempt organization retum for the organization named above. The extension
is for the organization's return for-
D BU calendar year 2 0 1 3 or
b [:3 tax year beginning . and ending

2 if the tax year entered in line 1 is for less than 12 months. check reason: [:1 initial return C3 Final retum
C] Change in accounting period
as If this application is for Forms QQGBL. 990-PF. 990T. 4720. or 6069. enter the tentative tax. less any
nonrefundable credits. See instnictions. 3a L L 186 .
b If this application is for Forms 990-PF, 990T. 4720. or 6069. enter any refundable credits and
estimated texpamients made. include any prMear overpayment allowed as a credit. 3b $ 5 L000 .
c Balance due. Subtract line 3b from line 3a Include your payment With this form. if reqmred.
by using EFiPS (Electronic Federal Tax Pament System). See instructions. L 5 O .
Caution. if you are going to make an electronic funds withdrawal (direct debit) wnh this Form 8868, see Form 8453-EO and Form 8879EO for payment
instmcttone.
LHA For Privacy Act and Paperwork Reduction Act Notice. see instructions. Form 8888 (Rev 1-2014)

You might also like