2026 Local Journalism Sustainability Tax Incentive Program Application

Local Journalism Sustainability Tax Incentive Program Application
You will need to have documents prepared to upload for this application.
1. Organizational Structure disclosure entered into this template.
2. Qualified Journalist information entered into this template.
Based on information provided during the application, the Department may require:
- IRS Form 990 for the most recently completed taxable year, demonstrating coverage of local or State news as the stated mission.
- Publicly posted board of directors or governance disclosure, if available.
- Beneficial ownership information, entered into the Department’s required template.
- Publicly posted beneficial ownership disclosure, if available.
- Three (3) representative local news stories.
- Documentation demonstrating an active United States Postal Service (USPS) periodicals permit, including one or more of the following:
  
  USPS Form 3541;
  
  PS Form 3526; or
  
  A recent mailing statement or invoice demonstrating active use of the permit.
- Analytics or audience measurement report, whether digital or broadcast market, that shows at least 33% of the audience is located in Illinois.
- Financial documentation showing Gross Receipts and Total Revenue, such as an income.
- Itemized PAC or political advertising documentation, including:
  
  Name of the payer;
  
  Date of receipt;
  
  Amount received.
- Common Paymaster Attestation, if applicable, entered into the Department's required template.
- PEO agreement, if applicable.
Please reference the statutes below for defining Political Action Committees (PACs) or other entities described in Section 527 of the Internal Revenue Code.

Political organizations | Internal Revenue Service

Please reference the statutes below for defining organizations that maintain tax-exempt status under Section 501(c)(4) or Section 501(c)(6) of the Internal Revenue Code.

Section 501(c)(6) | Internal Revenue Service
Section 501(c)(4) | Internal Revenue Service

Any incomplete or deficient applications will be denied with a reason and opportunity to appeal. This will delay any approval process, so please be sure to submit a complete and accurate application.

Please note: Once you enter your email address in this report, you have the ability to scroll down to the end and select "Save" to save your report as you go along. You will then receive an email with a link to your report so you can complete.
- APPLICATION INFORMATION
- Type of Application
- Please provide a detailed explanation regarding the reason for your appeal.
- LOCAL NEWS ORGANIZATION DETAILS
  
  Local News Organizations should apply at the level in which they independently meet the criteria under the definition of a Local News Organization in 35 ILCS 18/40-5.
- Local News Organization Name
  Provide the legal name of the organization. Ensure this matches official registration or tax documents.
- FEIN
  This should match the Local News Organization name listed above
- Website URL
- Address of the Local News Organization
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- County of the Local News Organization
  This is the county of the address of the Local News Organization.
- Type of Local News Organization
- Please select the option that best describes the digital aspect of your business
- Does the Local News Organization engage professionals to create, edit, produce, AND distribute original content concerning matters of public interest through reporting activities, including conducting interviews, observing current events, or analyzing documents or other information?
- Does the Local News Organization have at least one employee who meets ALL of the following criteria? 1) The employee is employed by the entity on a full-time basis for at least 30 hours a week; 2) The employee's job duties for the entity consist primarily of providing coverage of Illinois or local Illinois community news; 3) The employee gathers, prepares, collects, photographs, writes, edits, reports, or publishes original local or State community news for dissemination to the local or State community; AND 4) The employee lives within 50 miles of the coverage area.
- Provide the name of an employee who meets ALL of the criteria noted immediately above.
  
  First NameLast Name
- Provide the Illinois zip code closest to the employee's residence that falls within the coverage area of the Local News Organization.
- *INTERNAL REVIEW* Is the coverage zip code provided above in Illinois?
- *IR NOTES* (2b) - Provide a note as to why review of the application indicated the coverage zip code provided in the application was not in Illinois.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Provide the zip code of this employee's residence.
- *INTERNAL REVIEW* Is the residential zip code above within 50 miles of the coverage zip code provided?
- *IR NOTES* (2c) - Provide a note as to why review of the application indicated the residential zip code provided in the application was not within 50 miles of the coverage zip code.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- QUALIFIED JOURNALISTS
- Please upload the Local News Organization's completed Qualified Journalist Form.
  
  This form must be in the format of the template provided in the instructions at the beginning of this application.
  Cancelof
- Number of qualified journalists employed by the Local News Organization on January 1 of the preceding calendar year:
  Enter the value provided in (2)(a) of the instructions on the Qualified Journalist Form which will be attached to this application.
- Number of qualified journalists employed by the Local News Organization on January 1 of the calendar year for which this application is being submitted:
  Enter the value provided in (2)(b) of the instructions on the Qualified Journalist Form which will be attached to this application.
- Number of qualified journalists employed and paid by the Local News Organization during the 12-month period preceding the date this application is being submitted:
  Enter the value provided in (2)(c) of the instructions on the Qualified Journalist Form which will be attached to this application.
- *INTERNAL REVIEW* Number of qualified journalists who filled a NEW journalism position for the Local News Organization during the 12-month period preceding the date this application is being submitted.
- *INTERNAL REVIEW* Does (2)(a) in the LNO's Qualified Journalist Form equal "{numberOf}"?
- *IR NOTES* (14a) - Provide a note for the applicant detailing the discrepancy between the number of qualified journalists employed on January 1 of the preceding calendar year in the Qualified Journalist Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Does (2)(b) in the LNO's Qualified Journalist Form equal "{numberOf75}"?
- *IR NOTES* (14b) - Provide a note for the applicant detailing the discrepancy between the number of qualified journalists employed on January 1 of the calendar year for which this application is being submitted in the Qualified Journalist Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Does (2)(c) in the LNO's Qualified Journalist Form equal "{numberOf36}"?
- *IR NOTES* (14c) - Provide a note for the applicant detailing the discrepancy between the number of qualified journalists employed and paid during the 12-month period preceding the date this application is being submitted in the Qualified Journalist Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Does (2)(d) in the LNO's Qualified Journalist Form equal "{NumberOf30}"?
- *IR NOTES* (14d) - Provide a note for the applicant detailing the discrepancy between the number of qualified journalists who filled a new journalism position during the 12-month period preceding the date this application is being submitted in the Qualified Journalist Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- PAYROLL INFORMATION
- Is the Local News Organization required to deduct and withhold taxes as provided in Article 7 of the Illinois Income Tax Act?
- How does the applicant file Illinois payroll withholding? The tax credit certificate must be issued to the entity (FEIN) that files IL-941 and will claim the credit.
- Professional Employer Organization (PEO) Name
- Professional Employer Organization (PEO) FEIN
- Upload Professional Employer Organization (PEO)Agreement
  
  Upload documentation outlining shared responsibilities for payroll, benefits, and HR compliance under a co-employment arrangement.
  Cancelof
- Common Paymaster Name
- Common Paymaster FEIN
- Upload Signed Attestation from the Common Paymaster
  
  The required template can be found at the top of the page; you must obtain the signature of common paymaster and upload the signed attestation.
  Cancelof
- FINANCIAL INFORMATION
- Does the Local News Organization's taxable year run concurrently with the calendar year?
- Enter the dates of the Local News Organization's previous taxable year.
  MM/DD/YYYY-MM/DD/YYYY
- Has your organization received revenue from a political action committee (PAC), a Section 527 entity, or an organization with Section 501(c)(4) or 501(c)(6) tax-exempt status under the Internal Revenue Code within the previous year? (Please refer to the statute link/s provided at the beginning of the application for definitions of these sections.)
- Provide the total amount of the Local News Organization's gross receipts for the previous taxable year.
- Of the amount provided immediately above, provide the total amount of payments received from political action committees, other entities described in Section 527 of the federal Internal Revenue Code, and organizations that maintain Section 501(c)(4) or 501(c)(6) status under the federal Internal Revenue Code for the previous taxable year.
- Of the amount provided immediately above, provide the total amount of payments which were for political advertising during the lowest unit windows and using comparable rates for the previous taxable year.
- IR 01 Amount of payments from PACs, etc that are not for ads during lowest unit windows and using comparable rates:
- IR 02 Percentage of payments from PACs, etc that are not for ads during lowest unit windows and using comparable rates:
- Please upload the Local News Organization's Financial Statement reflecting the Gross Receipts information provided above.
  
  Reviewers of the application will need to be able to see the value provided for the total amount of the Local News Organization's gross receipts for the previous taxable year as it is entered above.
  Cancelof
- *INTERNAL REVIEW* Is the proof provided for gross receipts for the LNO's previous taxable year?
- *IR NOTES* (8b) - Provide a note for the applicant as to why review of the application indicated the proof provided for gross receipts was not for their previous taxable year.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Is the proof provided for gross receipts sufficient?
- *IR NOTES* (8c) - Provide a note for the applicant as to why review of the application indicated the proof provided for gross receipts was not sufficient.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Has the Local News Organization received more than $100,000 from political action committees, other entities described in Section 527 of the federal Internal Revenue Code, and organizations that maintain Section 501(c)(4) or 501(c)(6) status under the federal Internal Revenue Code in the current taxable year or any preceding taxable year?
- Provide the total revenue earned by the Local News Organization during the previous taxable year.
- Of the amount provided immediately above, provide the revenue earned from political advertisements during lowest unit windows during the previous taxable year.
- IR 03 Percentage of revenue from political advertisements during lowest unit windows:
- Please upload the Local News Organization's Financial Statement reflecting the Total Revenue information provided above.
  
  Reviewers will need to verify that the Total Revenue of the Local News Organization for the previous taxable year, as entered above, matches the amount reported in the Financial Statement.
  Cancelof
- *INTERNAL REVIEW* Is the proof provided for revenue for the LNO's previous taxable year?
- *IR NOTES* (9b) - Provide a note for the applicant as to why review of the application indicated the proof provided for revenue was not for their previous taxable year.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Is the proof provided for revenue sufficient?
- *IR NOTES* (9c) - Provide a note for the applicant as to why review of the application indicated the proof provided for revenue was not sufficient.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Please upload an itemized statement showing all revenue received from Political Action Committees (PACs), Section 527 entities, or organizations with Section 501(c)(4) or 501(c)(6) tax-exempt status under the Internal Revenue Code.
  
  Your document must include the following for each entity: Name of the organization, Date, and the Amount paid
  Cancelof
- *INTERNAL REVIEW 72* Did the applicant provide an itemized statement showing all revenue received from Political Action Committees (PACs), Section 527 entities, or organizations with Section 501(c)(4) or 501(c)(6) tax-exempt status under the Internal Revenue Code listing the Name of the organization, Date, and the Amount paid?
- *IR NOTES 72* Please provide a note as to why the applicant did not provide an itemized statement showing all revenue received from Political Action Committees (PACs), Section 527 entities, or organizations with Section 501(c)(4) or 501(c)(6) tax-exempt status under the Internal Revenue Code listing the Name of the organization, Date, and the Amount paid
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- PUBLISHING STANDARDS
- Has the Local News Organization published at least one print publication per month over the previous 12 months?
- Does the Local News Organization hold a valid United States Postal Service (USPS) periodical permit?
- Please upload the Local News Organization's USPS periodical permit.
  
  Acceptable documentation includes: A copy of a valid USPS Periodicals Class Mail permit (Form 3541 or PS Form 3526 or equivalent) or A recent mailing statement or invoice showing active use of the permit.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide a USPS periodical permit (Form 3541 or PS Form 3526 or equivalent) or A recent mailing statement or invoice showing active use of the permit)?
- *IR NOTES* (3c) - Provide a note as to why review of the application indicated they did not provide a USPS periodical permit (Form 3541 or PS Form 3526 or equivalent) or A recent mailing statement or invoice showing active use of the permit)?
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Was the USPS periodical permit provided above valid?
- *IR NOTES* (3d) - Provide a note as to why review of the application indicated the USPS periodical permit provided was invalid.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Does the Local News Organization dedicate at least 25% of its content to local news?
- Please provide images of three distinct stories, each published in a different month within the past 12 months, that focus on local news coverage. Ensure that the publication date is clearly visible in each image.
  
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide three distinct stories, each published in a different month within the past 12 months, that focus on local news coverage?
- *IR NOTES* (3g) - Provide a note as to why review of the application indicated they did not provide three distinct stories, each published in different month within the past 12 months, that focus on local news coverage.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Was the publication date for each of the stories mentioned above clearly visible in each image?
- *IR NOTES* (3h) - Provide a note as to why review of the application indicated the publication date for each of the stories mentioned were not clearly visible in each image.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Has the Local News Organization published one piece about the community per week over the previous 12 months?
- Does the Local News Organization have at least 33% of its digital audience in Illinois, averaged over a 12 month period?
- Please provide analytics report detailing audience numbers broken down by state for the previous 12-month period.
  
  For e.g. a Google Analytics report for the previous 12 months broken down by state
  Cancelof
- *INTERNAL REVIEW* Digital** Did the LNO provide analytics report detailing audience numbers broken down by state?
- *IR NOTES* (4c) Digital** Provide a note as to why review of the application indicated they did not provide an analytics report detailing audience numbers broken down by state.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Digital** Did the analytics report show the LNO had at least 33% of its digital audience in Illinois, averaged over a 12-month period?
- *IR NOTES* (4d) Digital** Provide a note as to why review of the application indicated the analytics report did not show that they had at least 33% of its digital audience in Illinois, averaged over a 12-month period.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Please upload Broadcast Radio Metrics demonstrating your listening audience is located in Illinois for the previous 12 months.
  
  The report can include signal coverage maps, tower contour data, Arbitron/Nielsen Audio data, market reach reports, or other audience measurement data demonstrating Illinois reach.
  Cancelof
- *INTERNAL REVIEW 96* Radio** Did the LNO provide data showing coverage area in Illinois over the last 12 months?
- *IR NOTES 96* (4c) Radio** Provide a note as to why they did not show data showing over 33% of the coverage area in Illinois over the last 12 months
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW 98* Radio** Did the data show at least 33% of its digital audience in Illinois?
- *IR NOTES 98* (4d) Radio** Provide a note for the applicant as to why review of the application indicated the analytics report did not show that they had at least 33% of its digital audience in Illinois, averaged over a 12-month period.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Please upload your broadcast audience metrics demonstrating your audience is located in Illinois for the previous 12 months.
  
  For e.g. Signal coverage maps, tower contour or radius maps, market reach or coverage reports.
  Cancelof
- *INTERNAL REVIEW* General Broadcast** Did the LNO provide broadcast audience metrics demonstrate the audience is located in Illinois for the previous 12 months?
- *IR NOTES* (4c) General Broadcast** Provide a note as to why they did not provide broadcast audience metrics demonstrating the audience is located in Illinois for the previous 12 months.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* General Broadcast** Did the Broadcast metrics show at least 33% of its digital audience in Illinois?
- *IR NOTES* (4d) General Broadcast** Provide a note as to why review of the application indicated the analytics report did not show that they had at least 33% of its digital audience in Illinois, averaged over a 12-month period.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Please upload broadcast television metrics demonstrating that your viewing audience is located in Illinois for the previous 12 months.
  
  For e.g. Nielsen Tv ratings, DMA data, signal contour maps, market reach reports
  Cancelof
- *INTERNAL REVIEW* TV** Did the LNO provide Broadcast television metrics demonstrating Illinois-based viewership for the last 12 months?
- *IR NOTES* (4c) TV** Provide a note as to why they did not provide Broadcast television metrics demonstrating Illinois-based viewership for the last 12 months?
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* TV** Did the Broadcast television metrics demonstrating Illinois-based viewership show at least 33% of its digital audience in Illinois?
- *IR NOTES* (4d) Digital** Provide a note as to why review of the application indicated the analytics report did not show that they had at least 33% of its digital audience in Illinois, averaged over a 12-month period.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- BENEFICIAL OWNERSHIP / GOVERNANCE
- Answer these questions based on the applicant listed on the application.
  - If you are applying at the legal entity/FEIN level, answer for that legal entity/FEIN.
  - If you are applying at the publication level, answer for the legal entity that owns and controls that publication.
  - DO NOT answer based on payroll processor, PEO, or common paymaster if one is used.
- The Local News Organization is a:
- Is the Local News Organization a publicly traded entity?
- Is the Local News Organization a subsidiary?
- Does the Local News Organization maintain tax status under 501(c)(3) of the federal Internal Revenue Code?
- Has the Local News Organization declared the coverage of local or State news as the stated mission in its filings with the Internal Revenue Service?
- Please upload the IRS Form 990, which includes the Local News Organization's mission statement.
  
  In the case of a 501(c)(3), has declared the coverage of local or State news as the STATED mission in its filings with the IRS.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide its IRS Form 990?
- *IR NOTES* (7b) - Provide a note as to why review of the application indicated the IRS Form 990 was not provided.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Does the LNO declare the coverage of local or State news as the stated mission in its IRS Form 990?
- *IR NOTES* (7c) - Provide a note as to why review of the application indicated they did not declare the coverage of local or State news in its stated mission in its IRS Form 990.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Has the Local News Organization disclosed in its print publication or on its website its beneficial ownership?
- Where does the Local News Organization disclose its beneficial ownership?
- Provide an image of the beneficial ownership disclosure, including date, in the most recent print publication.
  
  Please ensure the date of the publication is included in this image. Must have disclosed ownership details either in its print publication or on its website or, in the case of a not-for profit entity, its board of directors.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide an image of the beneficial ownership disclosure in their most recent print publication?
- *IR NOTES* (6.1b) - Provide a note for the applicant as to why review of the application indicated they did not provide an image of the beneficial ownership disclosure in their most recent print publication.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Did the beneficial ownership disclosure image include the date?
- *IR NOTES* (6.1c) - Provide a note for the applicant as to why review of the application indicated the beneficial ownership disclosure image did not include the date.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Provide a screenshot of the beneficial ownership disclosure, including date, on the Local News Organization website.
  
  Please ensure the date of the screenshot is included in this image.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide a screenshot of the beneficial ownership disclosure from its website?
- *IR NOTES* (6.1e) - Provide a note for the applicant as to why review of the application indicated they did not provide a screenshot of the beneficial ownership disclosure from their website.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Provide the direct URL for the beneficial ownership disclosure on the Local News Organization website.
  Must have disclosed ownership details either in its print publication or on its website or, in the case of a not-for profit entity, its board of directors.
- *INTERNAL REVIEW* Does the URL provided above include the beneficial ownership disclosure at the time of application?
- *IR NOTES* (6.1f) - Provide a note for the applicant as to why review of the application indicated URL provided did not include the beneficial ownership disclosure at the time of application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- What percentage of the beneficial ownership of the Local News Organization is owned, directly or indirectly, by a publicly traded entity?
  Example: 24.58% should be entered as 24.58. Enter the value provided in (2)(a) of the instructions on the Beneficial Ownership Form which will be attached to this application.
- Does the Local News Organization list a private fund among its beneficial ownership?
- Please upload the Beneficial Ownership Form.
  
  This form must be in the format of the template provided in the instructions at the beginning of this application.
  Cancelof
- *INTERNAL REVIEW* Does (2)(a) in the LNO's Beneficial Ownership Form equal {whatPercentage}%?
- *IR NOTES* (12 FINAL) - Provide a note for the applicant detailing the discrepancy between the percentage of their beneficial ownership owned, directly or indirectly, by a publicly traded entity, in their Beneficial Ownership Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Does (2)(b) in the LNO's Beneficial Ownership Form equal "{doesThe87}"?
- *IR NOTES* (13 FINAL) - Provide a note for the applicant detailing the discrepancy between listing a private fund among its beneficial ownership in their Beneficial Ownership Form and in their application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Has the Local News Organization disclosed in its print publication or on its website its Board of Directors?
- Where does the Local News Organization disclose its Board of Directors?
- Provide an image of the Board of Directors disclosure, including date, in the most recent print publication.
  
  Please ensure the date of the publication is included in this image.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide an image of the Board of Directors disclosure in their most recent print publication?
- *IR NOTES* (6.2b) - Provide a note for the applicant as to why review of the application indicated they did not provide an image of the Board of Directors disclosure in their most recent print publication.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- *INTERNAL REVIEW* Did the Board of Directors disclosure image include the date?
- *IR NOTES* (6.2c) - Provide a note for the applicant as to why review of the application indicated the Board of Directors disclosure image did not include the date.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Provide a screenshot of the Board of Directors disclosure, including date, on the Local News Organization website.
  
  Please ensure the date of the screenshot is included in this image.
  Cancelof
- *INTERNAL REVIEW* Did the LNO provide a screenshot of the Board of Directors disclosure from its website?
- *IR NOTES* (6.2e) - Provide a note for the applicant as to why review of the application indicated they did not provide a screenshot of the Board of Directors disclosure from their website.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Provide the direct URL for the Board of Directors disclosure on the Local News Organization website.
- *INTERNAL REVIEW* Does the URL provided above include the Board of Directors disclosure at the time of application?
- *IR NOTES* (6.2f) - Provide a note for the applicant as to why review of the application indicated URL provided did not include the Board of Directors disclosure at the time of application.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- Please upload your Organizational Structure disclosure
  
  This form must be in the format of the template provided in the instructions at the beginning of this application.
  Cancelof
- *INTERNAL REVIEW 156* Did the LNO provide a complete Organizational Structure Disclosure?
- *IR 156 NOTES*- Provide a note as to why the Organizational Structure Disclosure was Incomplete.
  This note will be provided to the applicant in their denial. Draft this response to have enough information for it to make sense to the applicant as a standalone comment.
- CONTACT INFORMATION
- Name
  
  First NameLast Name
- Title
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Would you like to provide a secondary contact to provide information in the event the primary contact is unavailable
- Secondary Contact Name
  
  First NameLast Name
- Secondary Contact Title
- Secondary Contact Email
  example@example.com
- Secondary Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- CERTIFICATION
- Authorized Executive Officer / Individual
- Name
  
  First NameLast Name
- Title
- Date
  
  MonthDayYear
  Date
- Signature
  
  Clear
- The Department of Commerce and Economic Opportunity (DCEO) is committed to protecting the privacy of its vendors, grantees and beneficiaries of programs and services. At times, DCEO will request social security numbers (SSNs) or other personal identifying information. Federal and state laws, rules and regulations require the collection of this information for certain purposes relating to employment and/or payments for goods and services, including, but not limited to, grants. DCEO also collects confidential information for oversight and monitoring purposes.
  
  Furnishing personal identity information, such as a social security number, is voluntary; however, failure to provide required personal identity information may prevent an individual or organization from using the services/benefits provided by DCEO as a result of state or federal laws, rules and regulations.
- Response email
  example@example.com
Should be Empty:

Local Journalism Sustainability Tax Incentive Program Application

APPLICATION INFORMATION

LOCAL NEWS ORGANIZATION DETAILS

QUALIFIED JOURNALISTS

PAYROLL INFORMATION

FINANCIAL INFORMATION

PUBLISHING STANDARDS

BENEFICIAL OWNERSHIP / GOVERNANCE

CONTACT INFORMATION

CERTIFICATION

Authorized Executive Officer / Individual