Application For Sales Tax Exemption {REV-72}

REV-72 (TR) 04-17 Fax or email completed application to: Fax: 717-787-3708 Email: ra-rvtrotaxspecialty@pa.gov INSTRUCTIONS FOR SALES TAX EXEMPTION APPLICATION SECTION 1 ­ REGISTRATION Institutions seeking exemption from sales and use tax must complete this application. Section 1 must be completed by all institutions. Please follow the instructions carefully to ensure all pertinent information and supporting documentation are supplied. All sections of the application must be completed in black ink. SELECT ONE OF THE FOLLOWING: NEW REGISTRATION: EXPIRED EXEMPTION STATUS: RENEWAL UPDATE: Applies to an institution that has never been registered with the PA Department of Revenue. Applies to an institution that was previously registered with the PA Department of Revenue, but has since ceased operations, failed to renew or whose exemption status was canceled. Applies to an institution that is currently exempt, but is seeking to have its exemption status renewed for another term. 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: Enter the legal name of the institution. Enter the Federal Employer Identification Number (EIN) assigned to the institution by the IRS. If the institution does not have an EIN, enter "N/A." If the institution submitted an application for an EIN, enter "applied for." Enter the name the institution is commonly known by (doing business as), if it is a name other than the legal name. If the trade name is the same as the legal name, enter "same." Enter the telephone number for the institution. Enter the physical location of the institution. A post office box is not acceptable. Enter the first date the institution conducted any activity. INSTITUTION TRADE NAME: TELEPHONE NUMBER: STREET ADDRESS: DATE OF FIRST OPERATIONS: LOCATION OF INSTITUTION'S Enter the address where the institution's records are kept. A post office box is not acceptable. RECORDS: Be sure to include the name of the county. MAILING ADDRESS: Enter the address where the institution prefers to receive mail, if at an address other than the institution's street address. A post office box is acceptable. American LegalNet, Inc. www.FormsWorkFlow.com 1 SUBSECTION B ­ TYPE OF ORGANIZATION Check the box or fill in the blank to indicate the type of organization that applies to the institution. Examples would include sole proprietorship, partnership, corporation and association. Enter the date of incorporation and the state of incorporation. If the institution is not incorporated, enter "N/A." Check the box to indicate whether the institution is operated for profit or as a nonprofit organization. If the institution has applied to and been approved by the IRS as tax-exempt, indicate under which section of the Internal Revenue Code the institution qualifies. Institutions are under a continuing obligation to immediately notify the PA Department of Revenue if there is any change in this status. If an institution has not applied with the IRS, enter "N/A." All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue any change in exemption status with the IRS. Institutions are required to report all changes within 10 days in writing to the department. Such changes include but are not limited to a revocation of the exemption status or receiving an individual exemption where the organization was previously covered under a group exemption status. All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue any court decision that may affect the institution's tax exemption status. The court decision may be within the state of Pennsylvania or any other jurisdiction. Institutions are required to report all changes within 10 days in writing to the department. All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue if the organization is currently being challenged by the IRS, the Commonwealth of Pennsylvania, a political subdivision or any for-profit entity. Institutions are required to report this information within 10 days in writing to the department. All correspondence should be sent to: Fax: 717-787-3708 Email: ra-rvtrotaxspecialty@pa.gov SUBSECTION C ­ ORGANIZATION INFORMATION All activities carried on by the institution for a period of three years should be reported. This explanation must contain a detailed description of how the beneficiaries are selected. Additional sheets can be attached to the application, should the response require more room than the space provided. If bylaws or IRS Form 990 explain the organizational purpose in detail, those documents can be used to complete this section. Attach any additional documentation such as brochures or pamphlets that explain the institution's purpose. SUBSECTION D ­ AFFILIATE INFORMATION In this section indicate whether the institution is affiliated with another organization. Affiliate is defined as a domestic or foreign corporation, association, trust or other organization that owns a 10 percent or greater interest in an institution of purely public charity. This definition also includes situations where an institution of purely public charity owns a