Application for Tax Exemption, Page 3 of 3, Applicant: ______________________________________
9. REQUIRED DOCUMENTATION
(a) Attach to this application your most recent financial statement, including, where applicable, IRS
Forms 900; 990; 990EZ; 990T; reflecting income and expenditures for the most current twelve
(12) month reporting period, which statement will become a part of this application. The attached
financial statement is for the period from _____________ to ______________.
(b) Attach a copy of the organization’s Constitution, By-Laws, Articles of Incorporation, and/or other
(c) Attach a list reflecting the names of all trustees or corporate/organization officers, the date
appointed or elected, and the court in which they qualified or identify the instrument in which they
were officially appointed.
(d) If investments, such as stock or bonds, are reflected on the financial statement, attach a list of all
such investments, including name of stock, date received and value.
(e) If applying for exemption by designation, please attach a check or money order made payable to
the ‘Commissioner of the Revenue’ in the amount of $350.00 for the applicable deposit for
publication as required under Section 27-32 of the City Code.
10. FILING DEADLINE AND EFFECTIVE DATE OF EXEMPTION
(a) For exemption by classification, the applicant may file at any time. The Commissioner of the
Revenue shall determine effective date of exemption based upon dates of qualifying ownership
(b) For exemption by designation, the applicant must submit a completed application with all
supporting documentation on or before November 1. Applications, if fully approved, shall then
take effect July 1 of the following year.
For additional information, please refer to Code of the City of Winchester §§27-31 - 27-37, available on
the City’s website. The office of the Commissioner of the Revenue will gladly provide assistance with the
Application completed by: ______________________________________________________________
Title: __________________________________ Date Submitted: ____________________________
Contact person: _________________________ Telephone Number: _________________________
I, __________________________________________, an appointed or elected Trustee/Officer for the
above named organization, certify under penalty of law that this application and all attachments hereto
have been examined by me and all information is true and correct.
Signature of Trustee/Officer: ____________________________________________________________
Title: ____________________________________________ Date: __________________________
Subscribed and sworn to before me this ______ day of _______________________________________
Notary Public: ________________________________________________________________________
My commission expires: ________________________________________________________________