Addition To Exemption Application Humanitarian Service Provider Page 2
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1
2Addition to Exemption
KSA 79-201 Ninth
Page 2 of 2
Enclose:
a.
A copy of the IRS designation letter showing exemption pursuant to I.R.C. §501(c)(3).
b.
A copy of the Articles of Incorporation and Bylaws if organization is organized not-for-
profit.
c.
A copy of the Certificate of Good Standing issued by the Secretary of State demonstrating
that the organization is currently active and in good standing.
VERIFICATION
I, ________________________________, do solemnly swear or affirm that the information set forth herein
is true and correct, to the best of my knowledge and belief. So help me God.
_______________________________________
Signature of Applicant
_______________________________________
Printed Name and Title
State of ____________________
)
County of __________________
)
This instrument was acknowledged before me on __________ by _______________________________.
Seal
_____________________________________
Signature of Notary Public
My appointment expires: ________________
Revised 7/14
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