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

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VIRGINIA DEPARTMENT OF TAXATION
REQUEST FOR EXTENSION OF SALES AND USE TAX EXEMPTION
Instructions: This form must be completed by all applicants that wish to extend an existing retail sales and use
tax 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. The law provides that failure to file
complete and timely information with the department could result in loss of the exemption. If you have any
questions, please contact the Department of Taxation at (804) 367-9359.
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: (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. Use the mailing
address on Page 4.

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