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877911 /06/200210:41 AM Form 8868 Application for Extension of Time To File an (December 2000) Exempt Organization Return OMB No. 1545-1709 Department of the Treasury Internal Revenue Service ® File a separate application for each return. ® If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ® If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form). Note: Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 88158. "M Automatic 3-Month Extension of Time- Only submit original (no copies needed) Note Form 990-T corporations requesting an automatic 6-month extension-check this box and complete Part I only All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 . Type or Name of Exempt Organization Employer identification number print File by the I . R . C . HEALTHY START COALITION INC 65 - 0363222 due date for Number, street, and room or suite no. If a P.O. box, see instructions. filing your 1603 10TH AVENUE return.rn. See instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. rVERO BEACH FL 32960 Check type of return to be filed (file a separate application for each return): Form 990 Form 990-T (corporation) Form 4720 Form 990-13L Form 990-T (sec. 401 (a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 Form 990-PF Form 1041 -A Form 8870 • If the organization does not have an office or place of business in the United States, check this box ® If this is for a Group Return, enter the organization's four digit Group Exemption NumberGEN ( ) . If this is for the whole group, check this box ® . If it is for part of the group, check this box b� 0 and attach a list with the names and EINs of all members the extension will cover. 1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until _ 2 / 17 / 03 to file the exempt organization return for the organization named above. The extension is for the organization's return for. P calendar year or 10* tax year beginning _ 7 / 01 / 01 , andending _ 6 / 30,L02 2 If this tax year is for less than 12 months , check reason: Initial return Final return Change in accounting period 3a If this application is for Form 990-BL, 990-PF , 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions . . . $ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Signature and Verification Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and co plete, and that I am authorized to prepare this form. Si nature P . / Title P L/�/�J Date Pop Nov 12 2002 For Paperwork Reduction Act Notic ee Instruction Form 8868 (12-2000) COPY DAA