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AP-204-2

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CLEAR FIELDS

(Rev.9-07/5)

APPLICATION FOR EXEMPTION -

FEDERAL AND ALL OTHERS

• TYPE OR PRINT

• Do NOT write in shaded areas.

1. Organizations applying for exemption under one of the categories listed below should check the appropriate box and complete this application.

Our publication, Guidelines to Texas Tax Exemptions (96-1045), includes a description of the additional documentation required for each category of

exemption. For the category you select, be sure to read the requirements listed in the publication. If you send in an application without including the

documentation described in the publication, we will return the application to you with a request for additional information. We are unable to

process incomplete applications.

Federal Exemption under qualifying Internal Revenue Code

Credit Unions - Federal

Section 501(c)

Credit Unions - State

Cemetery Corporations

Development Corporations

Certain Insurance Corporations for Farm Mutuals, Local Mutual Aid

Electric Cooperatives

Associations and Burial Associations

Emergency Medical Service Corporations

Certain Insurance Corporations Licensed as Title Insurance

Farmers Cooperative Societies

Companies and Title Insurance Agents

Health Facility Development Corporations

Certain Corporations subject to the Insurance Code

Hospital Laundry Cooperative Associations

Chambers of Commerce

Housing Finance Corporations

Convention and Tourist Promotional Agencies

Local Organizing Committees

Cooperative Associations

Lodges

Cooperative Credit Associations

Marketing Associations

Corporations Exempted by Another Law

Nonprofit Water Supply Corporations

Corporations with Business Interest In Solar Energy Devices

Open-End Investment Companies

Corporations Organized for Agricultural Purposes

Corporations Organized to Promote County, City or Another Area

(Public Interest Organizations)

Corporations Organized for Conservation Purposes

Corporations Involved with City Natural Gas Facility

Railway Terminal Corporations

Corporations Organized to Provide Cooperative Housing

Recycling Operations

Corporations Organized to Provide Convalescent Homes for

Telephone Cooperatives

Elderly

Texas Natural Research Laboratory Commission Corporations

Corporations Organized for Student Loan Funds or Student

Volunteer Fire Departments

Scholarship Purposes

Youth Athletic Organizations

2. ORGANIZATION NAME

(Legal name as provided on Articles of Incorporation, or if unincorporated, the governing document. If an out-of-state corporation, name must match the official corporate name as filed in the

home state of charter.)

3. ORGANIZATION MAILING ADDRESS

Street number, P.O. Box or rural route and box number

City

State/province

ZIP code

County (or country, if outside the U.S.)

4. Texas taxpayer number (if applicable) ............................................................................................................................

5. Federal employer's identification number

(EIN)

..............

(Required if applying for exemption on the basis of a federal exemption)

6. For TEXAS corporations, filing information issued by the Secretary of State:

Month

Day

Year

File Number ..............................................................

File Date ................................................

7. For NON-TEXAS corporations, filing information issued by the Texas Secretary of State:

Month