Instructions For Form 4 - Nebraska Exemption Application For Sales And Use Tax


WHO MAY FILE. An exemption application for sales and use
exemption certificate covering future purchases of similar
tax may be completed by any qualified organization wishing to
property for a period of three years from the date of issuance.
make purchases of property to be used by and for the purposes of
the organization without payment of sales and use tax.
Answer all questions on the front of this application. Questions
WHERE TO FILE. This application must be mailed to the
not relating to your organization should be answered by writing
Nebraska Department of Revenue, P.O. Box 94818, Lincoln,
N/A or “not applicable” on the appropriate line(s).
Nebraska 68509-4818.
LINE 1. If you currently have or have previously been issued a
QUALIFIED ORGANIZATIONS. Organizations qualifying for
Nebraska identification number such as a sales tax number,
a sales and use tax exemption include:
corporate identification number, or partnership identification
1. Organiza tions created exc lusively for religious
number, enter that number. Do not enter your social security
purposes (see Sales and Use Tax Regulation 1-091).
2. Nonprofit organizations providing services exclusively
LINE 2. Enter the federal employer identification number or
to the blind.
social security number which will be entered on your federal
3. Public or private Nebraska educational institutions
income tax return.
established under Chapter 79 or 85 of the Nebraska
LINE 3. Enter your business classification code from the
4. Nebraska licensed nonprofit hospitals.
805 Nonprofit skilled nursing facility, nonprofit intermediate
5. Nebraska licensed nonprofit skilled nursing facilities.
care facility, or nursing facility.
6. Nebraska licensed nonprofit intermediate care facilities.
806 Nonprofit hospital.
7. Nebraska licensed nonprofit nursing facilities.
809 Child-caring agency, nonprofit home health care
8. Nebraska licensed nonprofit home health care
organization, health clinic, child-placing agency.
829 School, college, university.
9. Nebraska licensed nonprofit health clinic, when owned
866 Organization created exclusively for religious purposes,
or controlled by two or more hospitals or the parent
nonprofit organization providing services exclusively to
corporations of the hospitals or which receive funds
the blind.
under the Urban or Rural Health Initiative Program of
the United States Public Health Service.
LINE 4. Briefly explain the activities or services provided by
your organization. If the activities or services are set out in a
10. Nebraska licensed child-caring agency. This agency
brochure, pamphlet, or other similar document, please include it
provides 24-hour daily care, supervision, custody, or
as part of this application.
control of children in lieu of care or supervision
normally exercised by parents in their own home, and
LINE 5. Enter the type of ownership under which your
licensed under sections 71-1901 to 71-1904.
organization is operated. A partnership includes any type of
partnership such as general, limited, and joint venture. A
An organization providing day care, early childhood
nonprofit corporation is one in which no part of the income is
programs, and periodic care as defined in section 71-
distributed to its members, directors, or officers. A domestic
1910 is not exempt as a child-caring agency.
corporation is one which was organized under the laws of this
11. Nebraska licensed child-placing agency. This agency is
state and has qualified to transact business in this state. A foreign
one that is authorized to place children in foster family
corporation is one which was organized under the laws of another
homes or to place children for permanent adoption.
state. A domesticated corporation is a foreign corporation that has
Nonprofit organization. The fact that an organization is
qualified to conduct activities in Nebraska.
nonprofit does not, by itself, entitle the organization to an
LINE 8. Enter the social security number, name, and address of
exemption from sales and use tax. The nonprofit organization
the owner(s). A sole proprietor must enter his or her social
must be one of the organizations listed in the above paragraph
security number, name, and address. A partnership should identify
before it can qualify for exemption. Suborganizations, though
each partner. A corporation should identify each corporate officer.
operating in support of or under the guidance of an exempt
A limited liability company should identify each member. If
organization, do not necessarily qualify for the exemption. A
additional space is required, attach a list using the same format.
sales and use tax exemption does not extend to a person or
LINE 9. Enter the location where your records are maintained to
organization purchasing property which will be given or donated
support the exempt purchases of the organization. If records are
to an exempt organization.
maintained at more than one location, enter the location where the
majority of your books and records are maintained. These records
the organization issued the exemption certificate may purchase
must contain sufficient information for the Nebraska Department
property which will be used by and for the purposes of the
of Revenue to verify the sales and use tax exemption.
organization without payment of sales and use tax. The
AUTHORIZED SIGNATURE. This application must be signed
organization must give its supplier a Nebraska Resale or Exempt
by the owner, member, partner, corporate officer, or other
Sale Certificate, Form 13, at the time of each purchase as proof of
individual authorized to sign by a power of attorney on file with
its exempt status. When an organization repeatedly makes the
the Nebraska Department of Revenue.
same type of purchase, it may give the retailer a blanket


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