ST-119.2-I
(12/13)
Instructions for Form ST-119.2
Application for an Exempt
Organization Certicate
Read these instructions carefully and complete all applicable sections on
the form. We cannot process an incomplete application.
Note: In addition to applying for an Exempt Organization Certicate to
make exempt purchases, if your organization makes sales through a
shop or store, or a restaurant, tavern, or other similar establishment,
it must register for sales tax purposes and collect and remit sales tax.
Also, your organization must register for sales tax purposes and collect
and remit sales tax if it makes any of the following sales, whether or not
made from a shop or store:
any lease or rental of tangible personal property;
any utility service described in Tax Law section 1105(b);
any service to real property described in Tax Law section 1105(c)(5); and
any tangible personal property where the sale is made by remote
means, such as by telephone, mail order (including email), over the
Internet, or by other similar methods, provided the sales are made
with a degree of regularity, frequency, and continuity.
Also, if the organization sells parking services or operates a hotel or
makes amusement charges, it must register for sales tax purposes
and collect and remit tax.
To register for sales tax purposes, visit the New York Business
Express at www.businessexpress.ny.gov to obtain a Certicate of
Authority.
Who should le this form
An organization described in Tax Law section 1116(a)(4), 1116(a)(5),
1116(a)(7), 1116(a)(8), or 1116(a)(9), should le Form ST-119.2 to apply
for an Exempt Organization Certicate. If the Tax Department issues
you an Exempt Organization Certicate, you may make tax-exempt
purchases.
Agencies of the United States and of New York State and its political
subdivisions should not use this form. They may make tax-free
purchases by presenting vendors with governmental purchase orders.
Units of the Boy Scouts of America and the Girl Scouts of the USA
should contact their local councils for the procedures they must follow to
establish sales tax exemption.
New York State Tax Law does not provide sales tax exemptions to other
states or their political subdivisions.
Where to le
Mail your completed application and all attachments to:
NYS TAX DEPARTMENT
SALES TAX EXEMPT ORGANIZATIONS UNIT
W A HARRIMAN CAMPUS
ALBANY NY 12227
Refunds for sales tax previously paid
Once you establish your exempt status, you may be entitled to a
refund of sales tax you previously paid if you met the requirements for
exemption when the purchases were made. However, if you had to
amend documents or change operations to qualify for exemption, you
are not entitled to a refund of taxes paid before the effective date of the
change.
Use Form AU-11, Application for Credit or Refund of Sales or Use Tax,
to request a refund. Keep sales slips and invoices to support your claim.
Refunds are generally subject to a three-year statute of limitations.
Specic instructions
Enter all applicable information and attach the requested documents.
Documents submitted with this application will not be returned, so be
sure to keep copies.
Enter the organization’s legal name (as it appears in its organizing
documents), telephone number, physical address, and mailing address.
Enter the name, title, telephone number, email address, and fax number
of the person to contact if we need more information or documentation
to make our determination. If the person is someone other than a trustee
or ofcer of the organization, this application must be accompanied by
a power of attorney executed by an authorized ofcer before we can
provide any information on the status of the application to the contact
person. Use Form ST-119.4, Application for an Exempt Organization
Certicate Power of Attorney.
If unincorporated, enter the date organized (i.e., the date that the
organizing documents were formally adopted). If incorporated, enter
the date the articles of incorporation were led with the appropriate
government agency.
Enter your federal employer identication number. (This number is not
proof of federal exemption as required on lines 8 and 9 below.)
Line 1a – Mark an X in the box on line 1a and any applicable additional
boxes to indicate the purpose for which you are claiming exempt status
if you are applying under Tax Law section 1116(a)(4). In addition to being
organized for one or more of the listed activities, you must meet the
following requirements:
No part of the organization’s net income can benet private
shareholders or individuals.
The organization cannot, as a substantial part of its activities, attempt
to inuence legislation. (If you have established federal exemption
under Internal Revenue Code (IRC) section 501(c)(3), that section will
govern the extent of legislative activities permissible. If not, the Tax
Department will make the determination.)
The organization cannot participate, directly or indirectly, in political
campaigns for or against candidates for public ofce.
The organization’s assets must be dedicated to its exempt purposes.
If it is dissolved or terminated, the assets must be distributed to
further one or more exempt purposes or to a federal, state, or local
government for a public purpose.
If organized to foster national or international amateur sports
competition, the organization may not provide athletic facilities or
equipment unless it is an amateur sports organization organized and
operated primarily to support and develop amateur athletes for, or to
conduct, national or international sports competition.
Line 1b – Mark an X in the box and indicate the percentages of each
type of member if you are applying under Tax Law section 1116(a)(5).
At least 75% of the organization’s membership must fall within the
rst category listed. In addition, you must be organized in New York
State, and no part of the organization’s earnings can benet private
shareholders or individuals.
Auxiliary units, societies of, or trusts or foundations for posts or
organizations may also qualify as exempt organizations if they show
that they were created by and are afliated with an organization
already exempted by the Tax Department. Attach a copy of the federal
determination letter conrming your IRC section 501(c)(19) exemption.
Line 1e – Mark an X in the box and attach a copy of your federal or New
York State charter if you are applying under Tax Law section 1116(a)
(9). Note: Effective March 1, 2008, all state-chartered credit unions, as
dened by New York State Banking Law section 2(9), will be exempt
from sales tax, regardless of when they were chartered. (For more
information regarding credit unions designated as exempt organizations,
see TSB-M-06(4)S, Credit Unions Designated as Exempt Organizations
for Sales and Use Tax Purposes.)
Lines 3 through 6 – Answer the questions on lines 3 through 6 by
marking an X in the applicable boxes. Answering Yes to a question will
not necessarily disqualify you, but you must attach an explanation.
Line 7 – If you answer Yes, attach an explanation of how you meet the
criteria of a qualied amateur sports organization as dened in Tax Law
section 1116(f).
Line 8 – Mark an X in the Yes box and attach a copy of the federal
determination letter conrming your IRC section 501(c)(3) exemption if
your organization has been granted exemption in its own name under
IRC section 501(c)(3). No other documentation is needed; however,
we reserve the right to request any additional information necessary to
make our determination.
Need help?
Telephone assistance
Sales Tax Information Center: (518) 485-2889
To order forms and publications: (518) 457-5431
Text Telephone (TTY) Hotline (for persons with
hearing and speech disabilities using a TTY): (518) 485-5082
accessible to persons with disabilities.
If you have questions
about special
accommodations for persons with disabilities, call the
information center.
Persons with disabilities: In compliance with the
Americans with Disabilities Act, we will ensure that our
lobbies, ofces, meeting rooms, and other facilities are
Visit our Web site at www.tax.ny.gov
get information and manage your taxes online
check for new online services and features
Line 9 – Mark an X in the Yes box if you are a subunit of an organization
that has a group IRC section 501(c)(3) exemption. Attach a copy of the
federal determination letter conrming your 501(c)(3) exemption and one
of the following:
a current letter from the “parent” organization certifying that the
subunit is a member of the organization and is included under the
federal 501(c)(3) exemption, or
a copy of the “parent” organization’s directory of subunits that lists this
subunit as one of those covered by the federal exemption.
If your organization has been granted federal exemption under some
other IRC section, attach a copy of the federal determination letter
conrming your exemption. All attachments are required.
If there is a discrepancy between the name and address as it appears on
the federal determination letter and on this application, please explain.
Line 10 – To qualify for exempt status, you must be formally
organized to conduct exempt activities and you must have organizing
documents specifying the activities. Mark an X in the appropriate box
to indicate your type of organization and attach copies of the required
organizing documents including any amendments to them (if you are
attaching a copy of the federal determination letter conrming your
IRC section 501(c)(3) exemption, you need not attach the organizing
documents). Note that these documents cannot be returned.
Line 11 – You must also attach the following to your application (unless
you are attaching a copy of the federal determination letter conrming
your IRC section 501(c)(3) exemption as previously noted):
Statement of activities – Describe your present and future activities in
detail. Do not use general statements or repeat the language of your
organizing documents. If you are not fully operational, explain what
stage of development you have reached, what remains to be done,
and when you will be fully operational.
Statement of receipts and expenditures
Statement of assets and liabilities – Assets are all real and personal
property; liabilities are all outstanding debts, of any nature.
If you do not have formal nancial statements, you may use the
following examples as a guide. Bank statements, copies of receipts,
invoices, and journal or ledger sheets are not acceptable substitutes.
Examples:
Name of Organization
Statement of receipts and expenditures
January 1, XXXX, through December 31, XXXX
Receipts:
Dues: membership 50 @ $2.00 $ 100.00
Contributions:
Voluntary contributions from members 500.00
Contributions from the public 1,000.00
Funding:
Department of Recreation 1,000.00
HUD 500.00
(submit copies of pertinent contracts)
Receipts from fund-raising activities:
Bake sale 150.00
Dinner dance tickets 600.00
Total receipts $3,850.00
Expenditures:
Fund-raising expenses
Bank, advertising, food $ 300.00
Contributions to:
Jonesville Fire Co. 50.00
St. Lukes Church 25.00
Operating expenses:
Electricity 600.00
Telephone 200.00
Fire insurance 300.00
Miscellaneous 50.00
Total expenditures $1,525.00
Name of Organization
Statement of assets and liabilities
As of December 1, XXXX
Assets:
Cash on hand: $ 200.00
Cash in bank: 1,500.00
Investments: Stock 10 @ $50.00 500.00
Ofce supplies and equipment 300.00
Buildings 20,000.00
Land: 5 acres 2,000.00
Other assets:
Bus 600.00
Total assets $25,100.00
Liabilities:
Accounts payable $ 00.00
Loans payable: Bank of NY 500.00
Mortgage payable: 10,000.00
Other liabilities:
Electric bill 60.00
Total liabilities $10,560.00
Signature – An ofcer of the organization must sign and date this
application. Be sure you have completed all applicable entries and
included true copies of all required documents. We will return any
incomplete applications to you. Keep copies of your application and all
attachments.
Page 2 of 2 ST-119.2-I (12/13)
Privacy notication
The Commissioner of Taxation and Finance may collect and maintain
personal information pursuant to the New York State Tax Law, including
but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697,
1096, 1142, and 1415 of that Law; and may require disclosure of social
security numbers pursuant to 42 USC 405(c)(2)(C)(i).
This information will be used to determine and administer tax liabilities
and, when authorized by law, for certain tax offset and exchange of tax
information programs as well as for any other lawful purpose.
Information concerning quarterly wages paid to employees is provided
to certain state agencies for purposes of fraud prevention, support
enforcement, evaluation of the effectiveness of certain employment and
training programs and other purposes authorized by law.
Failure to provide the required information may subject you to civil or
criminal penalties, or both, under the Tax Law.
This information is maintained by the Manager of Document
Management, NYS Tax Department, W A Harriman Campus, Albany NY
12227; telephone (518) 457-5181.
New York State and Local Sales and Use Tax
Application for an Exempt
Organization Certificate
State and Local Sales and Use Tax
ST-119.2
(9/11)
Name of organization Organization’s telephone number
( )
Physical address (number and street) City State ZIP code
Mailing address City State ZIP code
Name and title of person to be contacted (see instructions)
Contact person’s telephone number
( )
Email address of person to be contacted Contact person’s fax number
( )
Date formally organized Date incorporated Federal employer identication number
1a
Section 1116(a)(4) – Mark an X in the appropriate box to indicate the purpose for which you are claiming exempt status
(see instructions).
Religious Testing for public safety Prevention of cruelty to children or animals
Charitable Scientic Fostering national or international amateur sports competition
Educational Literary
1b Section 1116(a)(5) – A post or organization organized in New York State of past or present members of the United States
armed forces, or an auxiliary unit or society of, or a trust or foundation for, any such post or organization organized in
New York State (see instructions).
What percentage of your members are past or present members of the United States armed forces? ........ %
What percentage of your members are cadets or are spouses, widows, widowers, ancestors, or lineal
descendants of past or present members of the United States armed forces or of cadets? ...................... %
What percentage of your members do not fall within either of the above categories? ................................... %
If the post or organization has received a federal ruling on its exemption claim, attach a copy of the federal determination
letter conrming your Internal Revenue Code (IRC) section 501(c)(19) exemption.
1c
Section 1116(a)(7) – A not-for-prot corporation acting as a health maintenance organization subject to the provisions of
Public Health Law Article 44. You must attach a copy of the certicate of authority issued by the New York State Health Department.
1d Section 1116(a)(8) – A cooperative or foreign corporation doing business in this state pursuant to the Rural Electric
Cooperative Law.
1e Section 1116(a)(9) – A credit union, as dened by New York State Banking Law section 2(9), where it is the
purchaser, user, or consumer of services or property, or where it is a vendor of services or property of a kind not ordinarily
sold by private persons (see instructions).
2 Are you currently registered for sales tax purposes with the Tax Department? ................................................. Yes No
If Yes, enter your sales tax Certificate of Authority number .
If you answer Yes to questions 3 through 7, attach an explanation (see instructions).
3 Has any distribution of the organization’s property ever been made to shareholders, members, or other
individuals? ...................................................................................................................................................... Yes No
4
Does any part of the net earnings of the organization go to the benet of any private shareholder or individual?
.... Yes No
5 If you marked box 1a, has the organization ever attempted to inuence legislation? ........................................ Yes No
Mark an X in the appropriate box to indicate the Tax Law section under which you are claiming exempt status.
Signature of ofcer or trustee Date
Name and title of ofcer or trustee (please print)
Email address of ofcer or trustee
Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I
make these statements with the knowledge that willfully providing false or fraudulent information with this document may constitute a
felony or other crime under New York State Law, punishable by a substantial ne and possible jail sentence. I also understand that the
Tax Department is authorized to investigate the validity of any information entered on this document.
6 If you marked box 1a, has the organization ever participated or intervened, directly or indirectly, in any
political campaign or endorsed or opposed any candidate for public ofce? ................................................ Yes No
7 If you marked box 1a and the organization fosters national or international amateur sports competition,
does it provide any facilities or equipment, either directly or indirectly, to anyone? ....................................... Yes No
8 Has the organization
received an exemption from federal income tax under IRC section 501(c)(3)? .................
Yes No
(
If Yes, you must attach a copy of the federal determination letter conrming your IRC section 501(c)(3)
exemption.)
9
If you are a branch or chapter, has your parent organization received an exemption from federal income
tax under IRC section 501(c)(3) that applies to subordinate branches or chapters (see instructions)? ...........
Yes No
(If Yes, you must attach a copy of the federal determination letter conrming your IRC section 501(c)(3)
exemption.)
10 Mark an X in the appropriate box to indicate your type of organization (see instructions).
Corporation
(attach a copy of articles of incorporation, including filing receipt, and bylaws and any amendments to either of them)
Trust or foundation (attach a copy of Declaration of Trust and bylaws and any amendments to either of them)
Limited liability company (LLC) (attach a copy of articles of organization and operating agreement and any amendments to
either of
them)
Credit union (attach a copy of federal or New York State charter)
Other (attach a copy of constitution and bylaws and any amendments to either of them)
11 Attach the following to this application (see instructions):
• Statementofactivities fully describing all current and proposed activities.
• Statementofreceiptsandexpenditures for your most recent scal year of operation, clearly reecting the nature and
amount of receipts and the purpose and amount of expenditures. (If you have been in existence less than a year, submit a
statement of your receipts and expenditures to date, and a proposed budget for the rest of the year.)
• Statementofassetsandliabilities as of the end of your most recent scal year. (If you have been in existence less than a
year, your statement should be as of the date of this application).
• Note:Donotattach federal Form 1023, Application for Recognition of Exemption.
• Note:The Tax Department may require the applicant to submit additional documents and information.
ST-119.2 (9/11) (back)