Application For Exemption From Business, Professional And Occupational License Tax And/or Business Personal Property Tax
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1
2A
E
PPLICATION FOR
XEMPTION FROM
B
, P
O
L
T
USINESS
ROFESSIONAL AND
CCUPATIONAL
ICENSE
AX
/
B
P
P
T
AND
OR
USINESS
ERSONAL
ROPERTY
AX
F
N
-
C
, E
,
R
O
OR
ON
PROFIT
HARITABLE
DUCATIONAL
OR
ECREATIONAL
RGANIZATIONS
Organization Name:
_________________________________________________________________
Mailing Address:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Fairfax Location:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Contact Person:
_________________________________________________________________
Contact Title:
_________________________________________________________________
Contact Telephone/e-mail:
_________________________________________________________________
1.
What is the organization’s purpose?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
2.
What is the organization’s federal tax designation? (Circle one)
501(c)(3)
501(c)(4)
501(c)(6)
501(c)(7)
Other: 501(c)( ) (please insert #)
3.
How is the organization funded?
_____________________________________________________________________________________
_____________________________________________________________________________________
4.
When was the organization first established? ________________________________________________
5.
When did the organization begin operations in Fairfax County? _________________________________
6.
What activities or services are provided by the organization? Does it engage in any activities unrelated to
the purpose for which the organization was established? Please describe.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
7.
For what purposes are receipts used?
_____________________________________________________________________________________
_____________________________________________________________________________________
Fairfax County Department of Tax Administration, Personal Property Division
12000 Government Center Parkway, Suite 261
Fairfax, VA 22035
Phone: 703-222-8234; TTY: 703-222-7594; Fax: 703-324-4171
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