Advisory Committee on Tax Exempt and Government Entities (ACT ...

EXHIBIT D (CONTINUED)23. Have you included a copy of the first three pages of the Form 5500 (which includesemployee census information) and the applicable Financial Information Schedule of themost recently filed Form 5500 series return? Note: If a Form 5500 is not applicable,insert N/A and furnish the name of the plan, and the census information required of Form5500 series filers. (See section 11.03(1))24. Have you included a check for the VCP compliance fee, and, if applicable, a separatecheck for the determination letter fee each made payable to the U.S. Treasury? (Seesections 10.06 and 12.01))25. If your submission is for a terminating Orphan Plan, have you included a request for awaiver of the VCP fee? (See section 12.02(4))26. If you submitted a Notice of Intent to File VCP Application, have you included a copy ofthe Initial Notice and all Amended Notices? (See section [insert Rev. Proc. Section whenRev. Proc. Revised])27. Have you assembled your submission as described in section 11.14?SignatureDateTitle or AuthorityTyped or Printed Name of Person Signing ChecklistADVISORY COMMITTEE ON TAX EXEMPT AND GOVERNMENT ENTITIES (ACT) June 11, 2008 59