Ct-247, 2005, Application For Exemption From Corporation Franchise Taxes By A Not-For-Profit Organization

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CT-247
New York State Department of Taxation and Finance
Application for Exemption from Corporation Franchise
(8/05)
Taxes by a Not-for-Profit Organization
Legal name of corporation
Employer identification number
For office use only
Mailing name (if different from legal name)
c/o
Number and street or PO box
City
State
ZIP code
Principal business activity
Date tax exemption claimed from
For audit use only
Form of organization
Business/officer telephone number
(mark an X in the appropriate box)
(
)
Corporation
Association
Trust
Other
Date of formation
State or country of incorporation
Taxable
Exempt
Indicate exact name of the law under which the entity was formed (general corporation, not-for-profit, membership, etc.). Cite statutory provisions.
Federal return was filed on
:
Form 990
Form 990-T
Form 1120
Other:
(mark an X in one)
For lines 1 through 7, mark an X in the Yes or No box
1 Is the entity organized and operated as a not-for-profit organization? ...................................................................... Yes
No
2 Is the entity authorized to issue capital stock? (If Yes, also mark an X in the appropriate box below.) .................... Yes
No
Title holding company
Collective investment
Other:
List shareholders:
3 Does any part of the net earnings of the organization benefit any officer, director, or member? ............................. Yes
No
4 Does the entity meet the qualifications for exemption from federal income tax?
............. Yes
No
(See General information on the back.)
If No, stop. You do not qualify as an exempt organization.
5 Did the entity apply for federal exemption? .............................................................................................................. Yes
No
If Yes, indicate date of exemption
. Attach a copy of your federal exemption letter.
6 Is the entity engaged in an unrelated business activity at a location in New York State?......................................... Yes
No
7 Is the entity operating as a trust under section 401(a) and exempt from federal income tax under section 501(a)
of the Internal Revenue Code (IRC)? ................................................................................................................... Yes
No
8
List location and type of activity for each office and other places of business
(attach separate sheet if necessary).
Location
Nature of activity
9 List officers, employees, agents, and representatives in New York State and briefly describe their duties
(attach separate sheet if necessary).
Name
Title
Duties
10 List type and use of real property owned in New York State (
attach separate sheet if necessary).
Type
How used
11 Describe any New York State activities not shown above (
attach separate sheet if necessary).
Certification: I certify that this application and any attachments are to the best of my knowledge and belief true, correct, and complete.
Willfully filing a false application is a misdemeanor punishable under the Tax Law.
Signature of authorized person
Official title
Date
Signature of individual preparing this application
Firm’s name (
or yours if self-employed)
Address
City
State
ZIP code
ID number
Date

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