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SECTION B: EXEMPTION INFORMATION

1. If the exemption has been granted for purchases, what was the dollar amount, excluding sales tax, of

the taxpayer’s purchases of tangible personal property over the last three (3) years? Include taxable

services, if applicable. Estimates are acceptable. Exclude goods for resale, motor vehicles and fuel,

services, salaries, insurance, utilities, postage/shipping, rent/mortgage payments, depreciation, and

interest charges.

Year / Period

Annual Purchases Subject to Sales and Use Tax

Please note: if the information is not available for the years shown, please indicate time

periods for which this information is available and provide available information. You

can include necessary brief clarifications, such as fiscal year end dates, etc.

2. Do you expect purchases to change significantly in the future from what they have been in the recent

past? YES_____ NO______

3. If the exemption has been granted for sales, what was the dollar amount, excluding sales tax, of the

taxpayer’s sales of tangible personal property over the last three (3) years?

Exclude goods sold for resale, motor vehicles and fuel, services, salaries, insurance, utilities,

postage/shipping, rent/mortgage payments, depreciation, and interest charges.

Year / Period

Annual Sales Subject to Sales and Use Tax

Please note: if the information is not available for the years shown, please indicate

time periods for which this information is available and provide available information.

You can include necessary brief clarifications, such as fiscal year end dates, etc.

4. Do you expect a significant change to occur to your sales volume? YES _____ NO _____

5. To your knowledge, are there other businesses that perform a similar function requesting or receiving

this exemption? YES ______ NO ________ DON’T KNOW_________

If YES, please list the names of the similar businesses.

6. Please list other states that allow a similar exemption.

7. Do you qualify for other direct or indirect federal, state, or local government grants, subsidies, or

appropriations? YES ________NO _________DON’T KNOW______

If YES, please list the source, amount, and time period for the assistance received.

SOURCE / TYPE OF FUNDING

AMOUNT DATE

RECEIVED

__________________________

______________

________________

___________________________

______________

_________________

Please check the state and local taxes to which you are currently subject:

Corporation/ Individual Income_______SCC Gross Receipts_______Local Property______

Local Business License: List other state and local taxes you are subject to.

8. Are there other criteria, circumstances, or factors, including external statutory, constitutional, or

judicial mandates that should be considered when evaluating this exemption request?

Request Form For Extension Of Sales And Use Tax Exemption - Virginia Department Of Taxation Page 2