Application For Sales And Use Tax Exemption For Nonprofit Organizations - Virginia Department Of Taxation Page 3

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Section V - Financial Information
Enter the total dollar amount of the organization’s annual gross revenue (AGR), fundraising expenses, and
9.
administrative cost for the previous year. If you are a new organization and have no financial information at
this time, enter zero(s) in the applicable fields. If the annual gross revenue is less than $5,000, you must attach
a copy of the organizations mission statement or statement of purpose. See pages 2-3 of the instructions.
a) Enter organization’s total annual gross revenue for the previous year. ___________________
b) Enter organization’s total fundraising expenses incurred for the previous year. _____________
c) Enter organization’s total administrative cost for the previous year. ______________________
Section VI - Total Purchases and Sales Made in Virginia
10. Part I: Enter the total dollar amount of taxable purchases to be made in Virginia for the next year, the current
year, and the total taxable purchases made in the preceding year. Do not include the sales tax. Estimates are
acceptable. See page 3 of the instructions.
Annual Purchases Subject to Sales and Use Tax in Virginia
2013
2012
2011
Part II: Enter the total dollar amount of tangible personal property to be sold in Virginia for the next year, the
current year, and the total of tangible personal property sold in preceding year. Do not include the sales tax.
Estimates are acceptable. Failure to provide this information shall be the basis for the Department to refuse to
exempt your organization. See page 3 of the instructions.
Annual Sales Subject to Sales and Use Tax
(Complete only if you are exempt from collecting the sales and use tax on items sold in Virginia).
2013
2012
2011
11. Are you required to file a federal Form 990, 990-EZ, 990-PF, or 990-N with the IRS? See page 3 of the
instructions.
□
□
YES
NO
If yes, you must attach a copy of the form. If no, please provide the names, titles, addresses and telephone
numbers of only two members of the Board of Directors.
2
NAME: _______________________________
1.
NAME: _______________________________
TITLE: _______________________________
TITLE: _______________________________
ADDRESS: ____________________________
ADDRESS: ____________________________
CITY: ________________________________
CITY: ________________________________
STATE: _____
STATE: _____
ZIP: __________
ZIP: __________
PHONE NUMBER: (____)________________
PHONE NUMBER: (____)________________
FAX NUMBER: (____)___________________
FAX NUMBER: (____)___________________
EMAIL ADDRESS: _____________________
EMAIL ADDRESS: _____________________
Va. Dept. of Taxation
Rev. (1/1/2012)
Page
3

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