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Request Form For Extension Of Sales And Use Tax Exemption - Virginia Department Of Taxation

VIRGINIA DEPARTMENT OF TAXATION

REQUEST FOR EXTENSION OF SALES AND USE TAX EXEMPTION

Instructions: This form must be completed by all applicants that wish to extend an existing retail sales and

use tax exemption under the Educational (§ 58.1-609.4), Medical-related (§ 58.1-609.7), Civic and

Community Service (§ 58.1-609.8), Cultural (§ 58.1-609.9), or Miscellaneous (§ 58.1-609.10) categories. If

necessary, attach supplemental information to completely answer any question. The law provides that

failure to file complete and timely information with the department could result in loss of the exemption. If

you have any questions, please contact the Department of Taxation at (804) 377-3712.

PLEASE PRINT OR TYPE THIS APPLICATION

SECTION A: BUSINESS / ORGANIZATION NAME AND ADDRESS

Enter the Legal Business/Organization Name: ________________________________

Enter the Physical Address: (actual physical location of the business/organization)

Street _________________________________________________________________

City __________________ State __________________________ ZIP ________

Enter the name and mailing address of a contact person:

Name _________________________________ Phone _____________

Title ______________________________________________________

Street _____________________________________________________

City ________________________ State ______________________ZIP __________

**Optional: Please print your electronic mail address and /or fax number, if available:

_____________________________________________________________________

Enter the name of the city or county of the business/organization’s physical address:

_____________________________________

Enter the Federal Employer Identification Number (FEIN): _____________________

If registered for other Virginia taxes, enter the Virginia account number and taxes registered for:

Account Number Tax Types _____________________

Please report address changes to the Department of Taxation. Use the mailing address on

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Request Form For Extension Of Sales And Use Tax Exemption - Virginia Department Of Taxation