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Get Form 990bl (rev. January 1997). Information And Initial Excise Tax Return For Black Lung Benefit

545-0049 Under section 501(c)(21) of the Internal Revenue Code. See separate instructions. For calendar year 19 , or fiscal year beginning , 19 , and ending , 19 Name of trust Employer identification number of trust Name of other person filing return Social security or E.I. no. of other filer Number, street, and room or suite no. (If a P.O. box, see instructions) If application pending, check here City or town, state and ZIP code If address changed, check here FMV of assets.

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