Request For Sales And Use Tax Exemption - Virginia Department Of Taxation

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VIRGINIA DEPARTMENT OF TAXATION
REQUEST FOR SALES AND USE TAX EXEMPTION
Instructions: Sections A, B, C and D must be completed by all organizations seeking an exemption under the
educational (§ 58.1-609.4), medical-related (§ 58.1-609.7), civic and community service (§ 58.1-609.8), cultural (§
58.1-609.9), or miscellaneous (§ 58.1-609.10) categories. If necessary, attach supplemental information to
completely answer any question. If you have any questions, please contact the Department of Taxation at
(804) 367-1530.
PLEASE PRINT OR TYPE THIS APPLICATION
SECTION A: BUSINESS / ORGANIZATION NAME AND ADDRESS
1.
Enter the Legal Business/Organization Name: ___________________________________
2.
Enter the Physical Address: (the actual physical location of the business/organization)
Street ____________________________________________________________________
City
State
ZIP ____________
3.
Enter the name and mailing address of a contact person:
Name
Phone ___________________
Title
_______________________________________________________________________________
Street _________________________________________________________________________
City
State
ZIP _________________
***Optional: Please print your electronic mail address and/or fax number, if available:
_________________________________________________________________________
4.
Enter the name of the city or county of the business/organization’s physical address:_______
5.
Enter the Federal Employer Identification Number (FEIN): _______________________
6.
If registered for other Virginia taxes, enter the Virginia account number and taxes registered for:
Account Number
Tax Types _____________________________
Please report address changes to the Department of Taxation. Mail changes to the
address appearing on Page 4.

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