Form Np-20a - State Form 51064 - Nonprofit Application For Sales Tax Exemption

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Indiana Department of Revenue
NP-20A
Nonprofit Application for
Sales Tax Exemption
State Form 51064
(R/7-05)
NO FEE REQUIRED.
Part I
Full Name of Organization
This Area for Department Use Only
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Type
Mailing Address
City, State, Zip Code
County
Indiana Taxpayer Identification Number
Federal Identification Number
Date Incorporated
Enter the Month Your
or Formed:
Accounting Period Ends:
What is the predominant purpose of your organization?
Part II
1.
Indicate type of qualifying organization named in I.C. 6-2.5-5-21 (Check only one box in A, B, or C).
A. Organized specifically as a:
(1) Church
(3) Monastery/Convent
(5) Departmental Use Only
(7) Pension Trust
(2) Hospital
(4) Parochial School
(6) Labor Union
(8) Veteran's Group
B.
Organized and operated for one of the following reasons:
(1) Religious
(3) Scientific
(5) Educational
(7) VEBA
(2) Charitable
(4) Literary
(6) Civic
(8) Student Co-operative Housing
C.
Organized and operated as one of the following entities:
(1) Fraternal (including fraternal
(2) Departmental Use Only
(4) Business Association
beneficiary societies)
(3) Business League
2.
Does your organization sell or rent personal property for more than 30 days in a calendar year?
No
Yes
3.
Is this organization a local affiliate of a national or parent organization?
No
Yes--If so enter name and address of national or parent
organization.
4.
Has this organization previously applied for Indiana exempt status?
No
Yes--If so, please indicate previous registration number.
IMPORTANT --Attach one of the following documents that apply to your organization.
(a)
Copy of federal determination letter (ruling from the Internal Revenue Service) showing the section of the Internal Revenue Code exemption
from federal tax has been granted. To obtain a copy of federal determination letter or to apply for federal exemption, contact the IRS at:
1-877-829-5500
(b)
If incorporated, a copy of Articles of Incorporation and Bylaws. If not incorporated, a copy of Constitution and/or Bylaws, Articles of
Association, Declaration of Trust, copies of amendments, and any changes presently proposed.
Mail To:
Indiana Department of Revenue
Nonprofit Section, Room N203
100 North Senate Avenue
Indianapolis, Indiana 46204-2253
(317) 232-2188
I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and I have examined this
application, including the accompanying statements, and to the best of my knowledge it is true, correct and complete.
Name of Person(s) to Contact
Daytime Telephone Number(s)
Email Address
Signature
Title
Date Signed

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