Request For Sales And Use Tax Exemption - Virginia Department Of Taxation (Page 3 of 5) in pdf

Request For Sales And Use Tax Exemption - Virginia Department Of Taxation Page 3

Please check the state and local taxes to which you are currently subject.

Corporation/

Individual Income

SCC Gross Receipts

Local Property

Local Business License:

List other state and local taxes you are subject to.

Are there other criteria, circumstances, or factors, including external statutory, constitutional, or

judicial mandates, that should be considered when evaluating this exemption request?

SECTION C: BUSINESS / ORGANIZATION STRUCTURE

YOU MUST ATTACH THE RULING OR OTHER DOCUMENTATION FROM THE INTERNAL

REVENUE SERVICE TO INDICATE THAT THE ORGANIZATION IS EXEMPT FROM

FEDERAL INCOME TAX UNDER § 501 (c) OF THE INTERNAL REVENUE CODE.

Describe the charitable purpose(s) for which the business/organization is organized and

operated. Include the charitable functions, organization’s activities, and services provided to

Virginia citizens. Attach the Articles of Incorporation, Mission Statement, Statement of

Purpose or any other appropriate documentation.

Is more than 40 percent of the business/organization’s gross annual revenue, using generally

accepted accounting principles, spent on general administration, including salaries, and

fundraising? YES

NO _____

(Attach a financial statement or other proof to verify the 40 percent cost.)

List the address, if different from the physical address, where the business/organization’s

financial records are available for public inspection.

________________________________________________________________________________

List the salaries, including ALL benefits, for the five employees of the business/organization that

receive the highest compensation. You do not have to provide the names of the employees.

A. ____________________________

B. ____________________________

C. ____________________________

D. ____________________________

E. ____________________________

Is the business/organization’s gross annual revenue $250,000 or greater? YES

NO ____

If YES, you MUST attach the most recent financial audit that was performed by an

independent Certified Public Accountant.

Request For Sales And Use Tax Exemption - Virginia Department Of Taxation Page 3