HOW TO APPLY FOR WAL-MART AND/OR SAMS CLUB COMMUNITY GRANTS: 1. Print out the following contained in this PDF: (1) Wal-Mart grant applications (2 pages), and (2) IRS 501c3 EIN (Non-profit status) letter dated 2/23/04. 2. Insert your Lions Club contact information on the grant applications just below Liberty Day's signature of Andrew McKean. Please insert your Lions' Club name, contact name, address, and telephone number. 3. Visit the local Wal-Mart or Sams Store Manager. Please ask to submit an application for a local community grant. The store manager may refer you to the community grant manager. You will need to leave the grant application AND 501c3 non-profit tax letter with the store for processing if accepted. If the store has more than $1,000 available in grant money use the "vertical" grant application. If only $1,000 or less is available, please use the "horizontal" grant application. The Manager will complete the top portion of the application form including the "amount requested." Also you may inform the Manager that Liberty Day is already in their grant database! 4. Share important information with the Store and/or Grant Manager. Please inform the manager that their grant funds will benefit the local community by providing pocket copies of the U.S. Constitution and Declaration of Independence (and flashcards) to local school children. Tell them that most often the booklets will be used by local schools to celebrate Constitution Day on September 17th. Please offer them a sample copy of the Liberty Day pocket U.S. Constitution and flashcards. If you need a copy of the materials, let us know and we will provide one for you at our expense. Also inform the manager that your Lions Club is partnering with Liberty Day to provide the pocket Constitutions at cost and but at no cost to students. It is often helpful to tell the manager that we are working to teach students the meaning and importance of the U.S. Constitution and Declaration of Independence. 5. Please obtain the Posted Store Information. (1) Store Number, (2) Store Manager's name and phone number, and (3) Market Manager's name and phone number. (The "Market Manager" is the "area manager".) Wal-Mart posts this information on the wall in the customer service area. Please make a note of it and email it to me. This information will be useful when Liberty Day applies for state and/or national grants from Wal-Mart. 6. Follow-up. Wal-Mart will call you when a check for grant funds is available. You will need to pick-up the Wal-Mart check ( payable to Liberty Day) and forward it to Liberty Day. Often times Wal-Mart does a fun “check presentation” at its stores; your Lions Club may like to participate in this presentation. WMFCG:2-2-2009 . t ~,~ WaImar '1" Application for Community Grant Return completed form to the Walmart where you obtained this application Facility Use Only Facility # : City: Amount Requested: $_ _ _ _ _ _ _ _ _ _ _ _ __ ST: / Manager's Name (signed and printed): This application must be completed and kept il1 record retention for three years at your facility To be Completed by the Organization: Select one: IRS designated rn 501(c) (3)* organization OR: 0 Public School 0 Federal, State or Local Government Agency** 'Organizations must (1) have a current tax-exempt status under Section 501c (3) of the Internal Revenue Service Code, (2) must qualify as a public charity under Section 509(a)(l) or 509(a)(2 of the Internal Revenue Code, and (3) must be listed in the most current IRS 50 State Master File at the time of application " Any grant of funds to a governmental entity would be conditioned upon the funds being used exclusively for public purposes within the meaning of Section 501 (c)(3) of the Internal Revenue Code. Federal 501 (c)(3) Tax 10 #: Organization Name: Address:3615 S. (9 digits) 84 -1505465 ------------------------------------ Public Charity Status: 0 509(a) (1) or D 509(a) (2) ......L.TU'i~b..IJet::..Lr..lt-:yt'-J..D!.Ca~y~-------------------____________________ Tamarac Drive, Suite 320 Contact Name: Andrew McKean ST: ~Zip: City: Denver - 333 Contact Phone: 303 What service does your organization provide to the community? Help educate Americans, with a focus on our youth, 80237 - 3434 about the contents of the US Constitution and Declaration of Independence. Specifically, I)Qw will funds from this grant be utilized in. your local commurJity? To disErlbute, free of charge, coples of the Lloerty Day pocket Constitution book and a set of 24 Q&A's on flash cards to 5th graders to study and learn. If awarded a grant, will the funds be utilized within this LOCAL community? ~ Yes 0 No Which of the following groups will this funding primarily benefit? This information is used solely to track our funding to specific diverse community groups and is NOT considered during the grant review or approv~rocess. Please select only the most appropriate: Hispanic U African American 0 Asian American 0 Native American 0 Disab led Community Kl Other o [X By checking this box, Organization acknowledges that if awarded a grant, there is no obligation to buy merchandise from any Wal-Mart Stores Inc, location Organization Representative: By signing below I acknowledge that this form represents a request for funding, and is not a guarantee of funding. Final approval is subject to the guidelines of the Wal-Mart Foundation. All organizations requesting grant funding must abide by the rules and guidelines set forth by the location, Wal-Mart Stores, Inc., and the Wal-Mart Foundation. This request will not be pro~sed u1ess completed and signed ~ all parties. Signed: ~~J 21\ ()~ Printed: itr!'PUiJJ t\C'..f:EtJ Date: _1_1 _ __ WMFLCC-09 Walmart ~:~_ Application for Local Community Contribution Return comoleted fonn to the Walmart store where yOU obtained this aoolication Facility Use Only: Facility # : City: ST:_ _ Amount Requested: $ Managers Name (signed and printed) Date _ _I __1 This application must be completed and kept in record retention files for three years at your facility To be Completed by the Organization: Select one: IRS designated DO 501 (c) (3)' 0501 (c)(4) 0501 (c)(6) 0 501 (c) (19) • Organizations with current tax-exempt status under Section S01c (3) of the Internal Revenue Service Code and that are also public charities under Section 509(a) (1) or 509(a) (2). Organizations must be listed in the most current IRS 50 State Master File at the time of application OR: Public School 0 Federal, State or Local Government Agency' 0 Faith-Based Organization" • Any grant of funds to a governmental entity would be conditioned upon the funds being used exclusively for public purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code . •• Faith Based Organizations: funding purposes must address and benefit the needs of the community at large o Federal 501 (c) (3), (4), (6), or (19) Tax 10 #: (9 digits) 84-1505465 Public Charity Status: 0 509(a) (1) 0 509(a) (2) Organization Name: 36 ] 5 S Denver Address: City: Contact Name: Liberty Day Tamarac Dri:sze, Suite 32Q Zip: 80237 ST: CO Andrew McKean Contact Phone: 303 - 333 - 3434 Specifically, how will funds from this grant be utilized in your local community? c02ies of the Llberty Day pocket Constitution book and a set of 24 Q&A's on flash cards to 5th graders To distribute, free of charge l What service does your organization provide to the community? HeJp edllcate 8mericans, ~ith a focus Qn Qur: ::louth, about the contents of the US Constitution and Declaration of Independence. 5a By checking this box, Organization acknowledges that if awarded a grant, there is no obligation to buy merchandise from any Wal-Mart Stores Inc, location Which of the following groups will this funding primarily benefit? This information is used solely to track our funding to specific diverse community groups and is NOT considered during the grant review or approval process. Please select only the most appropriate: o Hispanic o African American o Asian American o Native American o Disabled Community ex Other Organization Representative: By signing below I acknowledge that this form represents a request for funding, and is not a guarantee of funding. Final approval is subject to the guidelines of the Wal-Mart Foundation. All organizations requesting grant funding must abide by the rules and guidelines set forth by the location, Wal-Mart Stores, Inc., and the Wal-Mart Foundation. This request will not be processed unless completed and signed by all parties. Signed: ~~ 9~printed: }oJ't}A..W M c~G\ "J Date:_I- . f Date: Bmpl.oyer Identification 84-1.505465 FEB 2 3 2004 JI'i]IIi'ger : DLH: ~705302471.5094 LIBERTY DAY Contact Person: . ERIC J BEB"'£!.sEN Contact -:reJ epbane Number: { 877} 829-5500 2::75 ::: ARAPAHOE RD STE 21.8 CEN"I'ENHIAL. CO 801.22 Pub~ic ~70 Dear :tDi 3l.323 Charity Status: (vil . ' (b) (1.) (A) Applicant: our letter dated November :1.999. stated you 1IOU.l.d be e'f""pL from Federal iDcome tax 'mder se.cc.i.an SOl.{el (3) of the Internal Bev!!nue Code. ami you would be trea.1:ed as a publie cbari.ty cbIri.D.g an advcmce rul.i.nw period. Based on our records ~ Oil t.hIi in£cn:ma.ti..an you subm'5.tb:ed. we are pl:eased t o . ccm.fi.rm that you are exe,'1+t, ' U!lder secti.On 501 (e) (3) of the COde, emil you :n-a classified as a public charity lmder the COde sec:t:i.cm 1i.sted in the ;bead; ng of this ~etter. · . Publicati.cm ~S7. Tax-Exempt Status for Your Cb:gdjtizatian. pcuvides deta:Ued i nformation abalit your ri¢.ts and respc:msilri.U.nes as an Axempt organization. You may request 'a copy by calling the toll-free 11DI1Iber lEar fm;ms , {800} 829-3676_ Information is al.so avaPab~e on our lInternet Web Si.te at www . irs.gov. I f you have general. ~ about e XHI{'L ozganizat;CDis. please can.. our toll-free number showJi il:i Fbe beading bee_en 8:00 a.a. - 6:30 p .- . Easte:m1 t.ime . . : P~ease keep t.b.i.s letter ±n.; . your permanent records . . ~f~ Lois G. Lel:ner . Director • ExeP!;'t orga:ti.za.t:ions Ru,l.i.ngs and ~ '- - ..-, -' :~.''-~._::- . ·useAcCOuNtNOMBER·: .•. t---:-..::::;=::.:..::=:..:::.~~~~~ for aI references 98-12798-0QOO 01 ". ____ __ - - ________ . __ ____ . __ 0_. ___ -- - :-:.-: - - - - - - - - - -- - - -.... - .- - - - - --.-.----.-.--.- ---..- ---.---- - _ .. - .. - - _. -_.' - .-- _. _--.