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G-B 1. Is the o~anization exempt from taxation pursuant to Sec. 50t (c) of the Internal Revenue Code of 19547 Yes ~ No C~B 2. Has a current annual alcoholic beverage license for serving alcoholic ,beverages been issued by the AB~Q Board to such organization for use on such property? Yes No ~ G-B 3. Is any director or officer of the organization paid compensation or salaf..y in excess of a reasonablg- allowance for services which such persons actually render? Yes. No ~ If y~s, explain. G-B 4. Yes_ DoesNo.anY p~I/t~e. If yes,neT Explain.earnings of such organization subscribe to the benefit, of any individual? Is any significant portion of the service provided by such organization generated by funds received from donations, contributions, or local, state, or federal grants? 'As used herein, donations shall includ~e.4he providing of personal services or the contributions of in-kind or material services. Yes No ~ G-B 5. Does the organization provide services for the common good of the public? Yes ~No G-B 6. Does a substantial part of the activities of the organization involve carrying on propaganda, or otherwise attempting to influence legislation, and does the organization participate in~p~r'intervene in, any political cam- paign on behalf of any candidate for public office? Yes No ~ G-B 7. Does any role, regulation, policy or practice of the organizatio~riminate on the basis of religious convictions, race, color, sex, or national origin? Yes No. ~ The resolution to be adopted must state that the provisions noted above have been examined and considered by the local govemmg body, and same would then be forwarded to the appropriate representatives in the General Assembly for presentation to the chairman of the committee before whom the legislation is pending: Prior to consideration by the committee of any such legislation, the committee chairman must determine that the local government entity the property is situated supports or refuses to support the exemption, or, if no action had been taken, that a formal timely request had been made to the governing body and that the governing body had failed to act on the request or otherwise refused to adopt the resolution. The enactment of a statute~ by the General Assembly exempting the organi- zation from taxation by designation is conclusive proof that the provisions of the section had been satisfied. ORGANIZATION BY: NAME '~J~"---,"~Zrr;~-.Z~' //~. "J~/~ TITLE ~-----,~,--~ -,-,~ a.~ .~.~ STATE OF VIRGINIA SS. CITY OF PORTSMOUTH deposes and says that he is the DATE named within the entitled application: that he has read the foregoing information sheet and knows the contents thereof"~ and that the same is true to his own knowledge ~except as to the matters here/n stated to be alleged upon information ahcl~e ~I~fT, ~nd as ~o those n~tters he betieves it~ be t~ffe.