Form Reg-1e - Application For St-5 Exempt Organization Certificate Page 2
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1
2NEW JERSEY DIVISION OF TAXATION
REG-1E (04-16)
APPLICATION FOR ST-5 EXEMPT ORGANIZATION CERTIFICATE
- FOR NONPROFIT EXEMPTION FROM SALES TAX -
Please review the instructions prior to filling in this form.
You must include the checklist on page 1 with the REG-1E. Please allow at least three weeks for processing a completed
REG-1E with required documents and issuance of the ST-5 Certificate.
Click in a shaded area to type your answers OR print form and neatly print your answers.
A. Organization Name
-
B. FEIN (if applicable)
C. Registered Corporate Alternate Name (if applicable)
D. Physical Location (an officer’s address may be used)
Street
City
State
Zip
E. Name and address where ST-5 is to be mailed
Name
Street
City
State
Zip
F. County/Municipality/or Out-of-State Code(codes are on next page)
G. Will you collect New Jersey Sales Tax?
Yes
No
If yes, give date of first sale _________/_________/________
Month
Day
(Collection not required if you have ST-5 exempt organization certificate and only make occasional sales)
H. Will you soon begin paying wages or salaries to employees working in NJ or to NJ residents?
(Answer “No” if you already withhold NJ income tax)
Yes
No
If yes, give date of first wage or salary payment ________/________/________and give date that gross payroll will exceed $1,000 ______/______/______
I. IF A CORPORATION, give State of Corporation _______, date ____/____/____ ATTACH copy of the Certificate/Articles of Incorporation.
J. Contact Person
Email Address
Daytime Phone
K. Provide the following information for 2 responsible officers.
NAME (Last Name, First, MI)
TITLE
HOME ADDRESS (Street, City, State, Zip)
I certify that all information given in this application is correct and also that any documents submitted are true copies.
Your Signature______________________________________________________________________________________________
Name and Title (please print)_______________________________________________________________ Date____/____/_____
Mail completed application with required documentation to:
OFFICIAL USE ONLY
DLN
NJ Division of Taxation
Regulatory Services Branch
Determination __________________________________
PO Box 269
Effective
Trenton, NJ 08695-0269
Date
__________________________________
Fax: (609) 989-0113
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