Form Dr 500 066 PDF Details

Did you know that the IRS has a new form specifically for 501(c) organizations? Form Dr 500 066 is for exempt organizations to request an advance ruling on their tax-exempt status. This form must be completed and submitted by your organization if it wants to seek a determination from the IRS about whether it qualifies for exemption under IRC 501(c). Knowing what this form is and how to complete it can help your organization avoid any delays in getting its tax-exempt status approved. Let's take a closer look at Form Dr 500 066 and what you need to do to fill it out properly.

Form NameForm Dr 500 066
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesimpairments, physiatrist, osteopathy, foregoing

Form Preview Example

Commercial Driver License

Intrastate Medical Waiver Application

Use this form to apply for an intrastate medical waiver if you have or are applying for a commercial driver license (CDL) and do not meet the minimum federal medical/vision standards. This form is not for drivers that do not have a CDL. Send this form and a complete copy (the DOT medical card is not sufficient) of your most current Medical Examination Report to:

Medical Unit, Driver Records

Department of Licensing

PO Box 9030

Olympia, WA 98507-9030

Fax: (360) 570-7893

Allow 7-10 business days for processing. Incomplete applications will not be processed.

PRINT or TYPE Driver name (Last, First, Middle initial)

Driver license number

Date of birth

(Area code) Telephone number

Describe the disqualifying medical condition(s) for this waiver


I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

I understand that false statements on this application may result in cancellation of my commercial driving privilege.




Physician use only–This section must be completed by a licensed medical doctor (MD), a doctor of osteopathy (DO), a board certified physiatrist (doctor of physical medicine), or an orthopedic surgeon. An optometrist or an ophthalmologist signature is acceptable for vision impairments and a certified nurse practitioner can sign only for monocular vision, color blindness, or hearing impairments.

PRINT or TYPE Medical examiner name and title

Office street address




ZIP code





(Area code) Telephone number

Professional license number







The above driver’s medical condition is not likely to interfere with the ability to safely operate a commercial motor vehicle

and is likely to remain stable for:

the next two years


Not more than two years


Medical examiner signature






DR-500-066 (R/1/12)WA

We are committed to providing equal access to our services. If you need accommodation, please call (360) 902-3900 or TTY (360) 664-0116.

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Stage # 1 of completing osteopathy

2. Soon after the prior part is completed, proceed to enter the suitable information in these - City, State, ZIP code, Area code Telephone number, Professional license number, Certification The above drivers, the next two years, other, Not more than two years, X Medical examiner signature, Title, Date, DR RWA, and We are committed to providing.

Completing section 2 in osteopathy

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