iates, 110 East 59th St. RoonVsinte a Telephone numb. pee page 11 of the nstructions) ( ) City of town, state, and ZIP code New York, NY 10022 C Ilexemption appricatca is pondne. check hem lv O D 1. Foreign organizations, check here . . li• O 2. Foreign oreanaalions meeting the 85% test. i—i check here