Form Tc-160 - Application For Sales Tax Exemption Number For Religious Or Charitable Institutions - 2011

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Utah State Tax Commission
TC-160
Application for Sales Tax Exemption Number for Religious or Charitable Institutions
Rev. 1/11
Name of organization
Mailing address
Physical address (if different from mailing address)
City
State
ZIP Code
City
State
ZIP Code
1. Per administrative rule R865-19S-43, applicant must document exemption status as follows:
A. Attach a copy of the IRS determination letter exempting your organization from federal income tax under IRC §501(c)(3);
B. If your organization is claiming exemption as a subunit of a central organization, attach a copy of the central organization’s
religious or charitable 501(c)(3) determination letter and IRS group exemption letter naming your organization as a subunit;
C. If your organization is not required to obtain an IRS determination letter, you must attach documentation (copies of your Articles
of Incorporation, Articles of Organization, or other similar documents) showing that your organization is exempt from tax under
IRC §501(c)(3); or
D. If your organization is a “disregarded entity” that does not have an IRS 501(c)(3) determination letter, attach the following
verification:
a) an affidavit or other evidence from the organization’s sole member that the organization is a “disregarded entity” within the
meaning of Federal Reg. §§301.7701-2 and 301.7701-3;
b) copy of the organization’s Articles of Organization; and
c) copy of the sole member’s IRS 501(c)(3) determination letter.
2. Federal Identification Number
of organization
3. Has this organization received or applied for a Utah franchise tax exemption letter from the Utah State Tax Commission?
Yes
No
Don’t know
Do you want to apply now?
4. Briefly state the specific purpose for which the organization was formed and the proposed means of obtaining funds to operate and
maintain the organization. Do not quote directly from Articles of Incorporation or other submitted documents.
5.
Do you now or do you expect to have sales income from an unrelated trade or business as defined by the
Yes
No
Internal Revenue Service?
Caution: Sales and Franchise tax exemptions do not apply to unrelated trade or business income.
If “Yes,” indicate approximate yearly amount: $ _ __ __ __ ___ __ __ __ __
Under penalties of perjury, I declare that to the best of my knowledge and belief, this application, including accompanying documents, is true, correct,
and complete. I further agree to make the organization's records available for an audit when the Tax Commission deems it necessary to verify the proper
use of the sales tax exemption account number.
Print name of officer or member
Telephone number of organization
Date
Signature of officer or member
Title
This form must be signed by hand after it is printed.
Print Form
Tax Commission Use Only
Date received
Approved
Denied
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
Clear form
Exemption number
Tax Commission authorized signature
X
RELIGIOUS AND CHARITABLE SECTION
Make a copy of this form for your records. Send the original to:
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC UT 84134
For more information, you may contact the Tax Commission by phone at 801-297-2200 or 1-800-662-4335. The fax number is 801-297-6358.
If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at 801-297-3811 or TDD 801-297-2020. Please
allow three working days for a response.

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