CITY OF NEWPORT NEWS
OFFICE OF THE COMMISSIONER OF THE REVENUE
Business Classification Information (BCI) – Supplement for Non-Profit
Organizations
Please complete a separate form for each business location in Newport News
Attach additional pages if space is not sufficient
For Assistance call 757-926-8651
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City Hall • 2400 Washington Avenue • Newport News, Virginia 23607 • Telephone: (757) 926-8651 • Fax: (757) 247-2628
Organization Name: ____________________________________________________________________________
PART I. TO BE COMPLETED BY ALL NON-PROFIT ORGANIZATIONS
1. IS THE ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC)
§501? IF YES, PROVIDE A COPY OF THE IRS LETTER OF DETERMINATION THAT STATES THE TAXABLE
STATUS OF THE ORGANIZATION. IF NO, STOP HERE!! YOU ARE NOT EXEMPT FOR BPOL TAX, PLEASE
FILE BCI.
2. DOES YOUR ORGANIZATION HAVE GROSS RECEIPTS FROM SOURCES OTHER THAN GIFTS,
CONTRIBUTIONS AND MEMBERSHIP DUES? IF YES, PLEASE EXPLAIN:__________________________________
___________________________________________________________________________
___________________________________________________________________________
PART II. TO BE COMPLETED BY ORGANIZATION DESCRIBED IN ITS 501(C)(3) ONLY
(EDUCATIONAL
INSTITUTIONS SHALL BE LIMITED TO SCHOOLS, COLLEGES & OTHER SIMILAR INSTITUTIONS OF LEARNING)
3. ARE CONTRIBUTIONS TO THE ORGANIZATION DEDUCTIBLE BY THE CONTRIBUTOR UNDER IRS
CODE§170?
4. DOES THE ORGANIZATION HAVE ACTIVITIES THAT PRODUCE UNRELATED BUSINESS TAXABLE INCOME
(UBTI) PER IRC §511? IF YES, PLEASE DESCRIBE NATURE OF TAXABLE INCOME:_________________________
___________________________________________________________________________
___________________________________________________________________________
5. IF UBTI FROM RETAIL ACTIVITY, HOW IS THE INVENTORY ACQUIRED (PURCHASED OR DONATED)?______
___________________________________________________________________________
___________________________________________________________________________
PART III. TO BE COMPLTED BY CHURCHES ONLY
6. PROVIDE NAME(S) OF TRUSTEE(S):___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
PART IV PLEASE PROVIDE A COPY OF THE FOLLOWING DOCUMENTS:
7. APPLICATION FOR EXEMPTION SUBMITTED TO THE IRS (FORM 1023, 1024 OR LETTER TO THE DISTRICT
DIRECTOR)
8. BYLAWS OR OTHER GOVERNING DOCUMENTS WHICH EXPLAIN THE PURPOSE(S) OF THE ORGANIZATION.
9. THE MOST RECENT IRS FORM 990 OR 990EZ (RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX)
FILED BY THE ORGANIZATION.
10. THE MOST RECENT IRS FORM 990T (EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN) FILED BY
THE ORGANIZATION.
11. IRS WRITTEN RULINGS OR DETERMINATION REGARDING UNRELATED BUSINESS INCOME.
This information is true and correct to the best of my knowledge and belief.
NAME OF AUTHORIZED AGENT (PRINT):_________________________________________________TITLE:____________________________
SIGNATURE OF AUTHORIZED AGENT:___________________________________________________DATE:_____________________________
Please notify this office immediately in the event of any changes in this information
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OFFICE USE ONLY – PHONE INQUIRY:
CONTACT PERSON ______________________________________________DATE___________________COR STAFF______________________
COMMENTS:______________________________________________________________________________________________________________
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