Fillable INSTRUCTIONS FOR SALES TAX EXEMPTION APPLICATION (Pennsylvania)

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INSTRUCTIONS FOR SALES TAX EXEMPTION APPLICATION (Pennsylvania)

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1
SECTION 1 – REGISTRATION



SELECT ONE OF THE FOLLOWING:
NEW REGISTRATION: 
EXPIRED EXEMPTION STATUS: 
 
RENEWAL UPDATE:                

REQUIRED DOCUMENTS - The documents identified below must be submitted along with this application. Please check
all boxes pertaining to your organization. Please include copies of the documents with the completed application.
REQUIRED DOCUMENTATION CHECKLIST
AN
INCORPORATED INSTITUTION MUST PROVIDE A COPY OF THE ARTICLES OF INCORPORATION SPECIFICALLY INCLUDING A
PROVISION PROHIBITING THE USE OF ANY SURPLUS FUNDS FOR PRIVATE INUREMENT TO ANY PERSON IN THE EVENT OF A SALE
OR DISSOLUTION OF THE INSTITUTION.
AN UNINCORPORATED INSTITUTION MUST PROVIDE A COPY OF THE BYLAWS OR ANY GOVERNING DOCUMENT SPECIFICALLY
INCLUDING A PROVISION PROHIBITING THE USE OF ANY SURPLUS FUNDS FOR PRIVATE INUREMENT TO ANY PERSON IN THE
EVENT OF A SALE OR DISSOLUTION OF THE INSTITUTION.
EVERY ORGANIZATION MUST PROVIDE A COPY OF THE MOST CURRENT FINANCIAL STATEMENT (A NEW ORGANIZATION CAN
SUBSTITUTE A PROPOSED BUDGET), INCLUDING ALL INCOME AND EXPENSES LISTED BY SOURCE AND CATEGORY.
IF THE INSTITUTION HAS BEEN GRANTED EXEMPTION BY THE INTERNAL REVENUE SERVICE (IRS), PROVIDE A COPY OF THE
DETERMINATION LETTER.
IF THE INSTITUTION FILES IRS FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, PROVIDE A COPY OF THE
MOST RECENTLY COMPLETED FORM WITH THE APPLICATION.
SUBSECTION A – INSTITUTION INFORMATION
INSTITUTION LEGAL NAME: 
FEDERAL EIN: 


INSTITUTION TRADE NAME: 

TELEPHONE NUMBER: 
STREET ADDRESS: 
DATE OF FIRST OPERATIONS: 
LOCATION OF INSTITUTION’S                
RECORDS:  
MAILING ADDRESS:                 

INSTRUCTIONS FOR
SALES TAX EXEMPTION APPLICATION

Fax or email completed
application to:


Go Directly To Application
SUBSECTION B – TYPE OF ORGANIZATION
                      











        


 




SUBSECTION C – ORGANIZATION INFORMATION
                  



SUBSECTION D – AFFILIATE INFORMATION
     





         

2
3
SUBSECTION E – OFFICER INFORMATION



ANNUAL COMPENSATION: 

OTHER BENEFITS AND 
AMOUNTS OF EACH:              

SUBSECTION F – SALARY INFORMATION


NAME: 

POSITION: 
SALARY: 
OTHER BENEFITS AND 
AMOUNTS OF EACH:              

SECTION 2 – FINANCIAL INFORMATION
 





 


PART 1 – BASIC QUESTIONS
LINE 1 – 



            

LINE 2 – 
 
   

LINE 3 – 



      

LINE 4 – 





LINE 5 – A. 

      

B. 
LINE 6 – 

LINE 7 – 


LINE 8 – 

LINE 9 – 

LINE 10 –     

Volunteer fire companies and churches should stop here.
PART 2 – RECIPIENT INFORMATION
LINE 1 –                


LINE 2 – 

LINE 3 – 

LINE 4 –                

4

NAME OF INDIVIDUAL OR NUMBER OF INDIVIDUALS HOURS PER WEEK WEEKS PER YEAR


  
LINE 5 – 

LINE 6 – (A) 

(B) 

(C                



PART 3 – GOODS OR SERVICES PROVIDED
LINE 1 – 

LINE 2 – 



LINE 3 – 
                     




LINE 4 – 

LINE 5 – 

LINE 6 –         

LINE 7 – 

LINE 8 – 
             

LINE 9 – 

LINE 10 – 
LINE 11 – 
              
       


5
LINE 12 – 

                  

PART 4 – FUNDRAISING ACTIVITIES
LINE 1 – 

               


SUBSECTION D – AUTHORIZED SIGNATURE
SIGNATURE OF               
CORPORATE OFFICER: 

TYPE OR PRINT NAME: 

PREPARER’S NAME: 
FAX OR EMAIL COMPLETED
APPLICATION TO: 


6
7
SECTION 1 – REGISTRATION



o

o

o

REQUIRED DOCUMENTATION CHECKLIST
AN INCORPORATED INSTITUTION MUST PROVIDE A COPY OF THE ARTICLES OF INCORPORATION SPECIFICALLY INCLUDING A
PROVISION PROHIBITING THE USE OF ANY SURPLUS FUNDS FOR PRIVATE INUREMENT TO ANY PERSON IN THE EVENT OF A SALE
OR DISSOLUTION OF THE INSTITUTION.
AN UNINCORPORATED INSTITUTION MUST PROVIDE A COPY OF THE BYLAWS OR ANY GOVERNING DOCUMENT SPECIFICALLY
INCLUDING A PROVISION PROHIBITING THE USE OF ANY SURPLUS FUNDS FOR PRIVATE INUREMENT TO ANY PERSON IN THE
EVENT OF A SALE OR DISSOLUTION OF THE INSTITUTION.
EVERY ORGANIZATION MUST PROVIDE A COPY OF THE MOST CURRENT FINANCIAL STATEMENT (A NEW ORGANIZATION CAN
SUBSTITUTE A PROPOSED BUDGET), INCLUDING ALL INCOME AND EXPENSES LISTED BY SOURCE AND CATEGORY.
IF THE INSTITUTION HAS BEEN GRANTED EXEMPTION BY THE INTERNAL REVENUE SERVICE (IRS), PROVIDE A COPY OF THE
DETERMINATION LETTER.
IF THE INSTITUTION FILES FORM 990, PROVIDE A COPY OF THE MOST RECENTLY COMPLETED FORM WITH THE APPLICATION.
SUBSECTION A – INSTITUTION INFORMATION
 


 
 
 
  


SUBSECTION B – TYPE OF ORGANIZATION
 
o
 
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APPLICATION FOR
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SUBSECTION C – ORGANIZATION INFORMATION
PROVIDE A DETAILED DESCRIPTION OF THE PAST, PRESENT AND PLANNED FUTURE ACTIVITIES OF THE INSTITUTION FOR A PERIOD
OF THREE YEARS. INCLUDE A DESCRIPTION OF HOW BENEFICIARIES ARE SELECTED.
SUBSECTION D – AFFILIATE INFORMATION
ARE YOU A NONPROFIT PARENT CORPORATION THAT ELECTS TO BE CONSIDERED AS A
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LIST EACH AFFILIATE, ITS ADDRESS, THE DATE OF AFFILIATION/SUBSIDIARY, PERCENT OF OWNERSHIP IN EACH, THE TYPE OF
INSTITUTION, THE RELATIONSHIP AND WHETHER IT IS ORGANIZED AS A FOR-PROFIT OR NONPROFIT INSTITUTION. ATTACH
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NAME OF AFFILIATE FEDERAL EIN PERCENT OF OWNERSHIP
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NAME OF AFFILIATE FEDERAL EIN PERCENT OF OWNERSHIP
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SUBSECTION E – OFFICER INFORMATION
THIS SECTION MUST BE COMPLETED IN FULL BY EVERY INSTITUTION, EVEN IF THE INSTITUTION DOES NOT COMPENSATE ITS
OFFICERS. THE ANNUAL COMPENSATION SHOULD INCLUDE THE OFFICER’S SALARY FROM THE INSTITUTION, CONTRIBUTIONS MADE
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LAST NAME FIRST NAME TITLE ANNUAL COMPENSATION
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LAST NAME FIRST NAME TITLE ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME FIRST NAME TITLE ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
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SUBSECTION F – SALARY INFORMATION All organizations must complete this information.
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  

  

  

  

SECTION 2 – FINANCIAL DATA


PART 1 – BASIC QUESTIONS
(1)              


ACTIVITY DOLLAR AMOUNT





TOTAL REVENUE
(INCLUDING AMOUNTS LISTED
ON SEPARATE SHEETS)
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(2) 


ACTIVITY DOLLAR AMOUNT
TOTAL EXPENSES
(INCLUDING AMOUNTS LISTED
ON SEPARATE SHEETS)
(3) 
 
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(4) 
             



 
NAME OF INDIVIDUAL OR NUMBER OF INDIVIDUALS HOURS PER WEEK WEEKS PER YEAR
(5) A. 
B. 
(6) 
(7) 
(8) 

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(9) 
(10) 


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PART 2 – RECIPIENT INFORMATION
(1) 
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
(2) 


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(4) 


(5) 


(6)(A) 

 
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(B) 
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(C) 
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

(A)  
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(B)  
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(C) 
 
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(D)
 
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(E) 
 
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(F)  
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(G) 
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(H) 
o
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        

 


        
       
        
         

PART 3 – GOODS OR SERVICES PROVIDED
(1) 


(2) 


(3) 


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 
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(10) 
 
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(11) 

(12) 

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(13) 

(14)            

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(1) 


 
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  
   
 
FAX OR EMAIL COMPLETED APPLICATION TO:
Fax: 717-787-3708
Email:
ra-rvtrotaxspecialty@pa.gov
APPLICATION FOR
SALES TAX EXEMPTION
12
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INSTRUCTIONS FOR SALES TAX EXEMPTION APPLICATION (Pennsylvania)

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Completed 16 February 2021

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