Request For Sales And Use Tax Exemption - Virginia Department Of Taxation Page 2

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SECTION B: EXEMPTION INFORMATION
The requested exemption is applicable only to purchases of tangible personal property by the
organization. This is in accordance with Code of Virginia § 30-19.05.
1.
Please indicate the dollar amount, excluding sales tax, of the taxpayer’s purchases of tangible
personal property over the last three (3) years. Estimates are acceptable.
(Exclude goods for resale,
motor vehicles and fuel, services, salaries, insurance, utilities,
postage/shipping, rent/mortgage payments, depreciation, and interest charges).
Year / Period
Annual Purchases Subject to Sales and Use Tax
Please note: if the information is not available for the years shown, please indicate time
periods for which this information is available and provide available information. You
can include necessary brief clarifications, such as fiscal year end dates, etc.
2.
Do you expect purchases to change significantly in the future from what they have been
in the recent past?
YES
NO _______
If yes, please provide your good faith numeric estimate of such purchases. Remember, this is just
your best numeric estimate, your actual future purchases may turn out to be significantly
different.
Year / Period
Annual Purchases Subject to Sales and Use Tax
You can include necessary brief clarifications, such as fiscal year end dates, etc.
3.
To your knowledge, are there other organizations that perform a similar function requesting or
receiving this exemption? YES
NO
DON’T KNOW _____
If YES, please list the names of the similar organizations.
4.
Please list other states that allow a similar exemption.
5.
Do you qualify for other direct or indirect federal, state, or local government grants, subsidies, or
appropriations? YES
NO
DON’T KNOW ______
If YES, please list the source, amount, and time period for the assistance received.
SOURCE/ TYPE OF FUNDING
AMOUNT
DATE RECEIVED
__________________________________________________________________________
__________________________________________________________________________

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