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Cie Form 113 - Application For Religious Institution Letter Of Exemption - Florida Department Of Education

FLORIDA DEPARTMENT OF EDUCATION

COMMISSION FOR INDEPENDENT EDUCATION

Mail Completed Application to:

Florida Commission

for Independent Education

325 West Gaines Street, Suite 1414

Tallahassee, FL 32399

APPLICATION FOR RELIGIOUS INSTITUTION

LETTER OF EXEMPTION

SECTION 1005.06(1)(f), F.S./ RULE 6E-5.001, Fla. Admin. Code

Please print or type.

Name of Religious Institution

________________________________________________________________________

Physical Address of Religious Institution

________________________________________________________________________

City:___________________________ State:___________ ZIP_____________________

Telephone Number: _____________________________________________

Fax Number:*

_____________________________________________

Email:*

_____________________________________________

Website:*

_____________________________________________

* If available

Mailing Address of Institution or Representative (if different from address listed above):

________________________________________________________________________

City:___________________________ State:___________ ZIP_____________________

Name and Title of Person Executing Sworn Affidavit (Affiant must be an Officer,

Director or person holding similar office with the religious institution):

Name:__________________________________________________________________

Title:___________________________________________________________________

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CIE Form 113, Effective June 22, 2009

Cie Form 113 - Application For Religious Institution Letter Of Exemption - Florida Department Of Education