Application Form For Sales And Use Tax Exemption For Nonprofit Organizations Form - Virginia Department Of Taxation (2010) Page 4


12. Is the organization subject to Chapter 5 (§ 57-48 et seq.) of Title 57 of the Code of Virginia relating to
charitable solicitation of contributions? See pages 3-4 of the instructions.
If YES, you must provide proof of compliance. Proof of compliance shall be documentation, which reflects
registration with the Virginia Department of Agriculture and Consumer Services (VDACS). Check No, if you
are not required to register. For information on obtaining this documentation, please contact VDACS at (804)
Section VII - Signature
I declare that this organization’s financial information is true, accurate, and complete.
___________________________________________________________ Date __________________
Authorized Representative
MAILING INFORMATION: Send completed form with attachments or change of address to:
Virginia Department of Taxation
Virginia Department of Taxation
Office of Customer Services
Office of Customer Services
Nonprofit Exemption Unit
Nonprofit Exemption Unit
Post Office Box 27125
600 East Main Street
Richmond, Virginia 23261-7125
Richmond, Virginia 23219
Telephone Number (804) 371-4023
Telephone Number (804) 371-4023
Fax: 804-786-2645
Fax: 804-786-2645
Please make sure all questions are answered and that the following documents are included with
the application, if required:
501(c)(3) or 501(c)(4) - IRS Determination Letter
Independent Financial Audit or Review from an Independent Certified Public Accountant
Mission Statement or Statement of Purpose
Federal Form 990, 990EZ, 990N, or substitute form
Proof of Chapter 5 Compliance- Solicitation of Contributions
Authorized Representative’s Signature
Estimate of Total Taxable Purchases in Virginia (estimates are acceptable)
NOTE: Incomplete applications will not be processed
Va. Dept. of Taxation
Rev. (12/31/2010)
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