Form Rv-F1319201 - Application For Exemption - Franchise And Excise Taxes
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APPLICATION FOR EXEMPTION
FRANCHISE AND EXCISE TAXES
COMPLETE THIS APPLICATION TO REQUEST EXEMPT STATUS FROM FRANCHISE AND EXCISE TAXES
1. REASON FOR APPLICATION
2. TAX PERIOD COVERED
New Exemption
Start:
End:
3. Effective date of registration with the Secretary of State:
SOS Number
4. ENTITY NAME AND PHYSICAL LOCATION
5. ENTITY MAILING ADDRESS
Name:
Name:
Street:
Street:
City, State, Zip:
City, State, Zip:
(
)
(
)
6. BUSINESS TELEPHONE NUMBER:
Fax #:
7. Current Franchise and Excise Tax Account Number:
FEIN:
8. ENTITY TYPE
Limited Liability Company
Limited Liability Partnership
Limited Partnership
Other Non-corporate Entity (Specify):
9. IDENTIFY TENNESSEE CODE SECTION AND REASON FOR REQUESTING FRANCHISE AND EXCISE TAX EXEMPTION.
(Please check one) (See reverse side for Exemption Criteria)
Venture Capital Fund [67-4-2008(a)(6)] - Dealing in securities primarily in non-publicly traded companies and capital is
primarily derived from investments neither related to nor affiliated with the fund.
LLC/LP/LLP Farming/Personal Residence [67-4-2008(a)(6)] - 66.67% of income is earned from either farming or holding
personal residences, including contiguous acreage, where at lease one partner or member resides, and is 95% owned by
persons who are relatives.
LLC/LP/LLP Security 3rd Party Indebtedness [67-4-2008(a)(7)] - 98% owned by corporate members of an affiliated group
and formed and operated for the exclusive purpose of acquiring indebtedness from members of the group.
LLC/LP Affordable Housing [67-4-2008(a)(8)] - Must haved allocation of low-income tax credits and must have an extended
low-income housing commitment for each building.
Obligated Member Entity [67-4-2008(a)(9)] - Appropriate documentation must be filed with the Secretary of State as an
obligated member or owner of an obligated member providing limited liability protection.
REMIC or FASIT [67-4-2008(a)(10)] - Real estate mortgage investment conduit or financial asset securitization investment
trust whose purpose is asset-backed securitization of debt obligations.
Family-Owned Non-corporate Entity with Farming/Passive Investment Income [67-4-2008(a)(11)] - At least 95% family-
owned and substantially all of income from passive investment income or farming. Entities having no income cannot
qualify for this exemption.
Diversified Investment Fund [67-4-2008(a)(12)] - At least 90% of total assets are qualifying investment securities, deposits
at financial institutions, and office space and equipment necessary to carry on business. At least 90% of income is from
interest, dividends, and gains from the sale of investment securities. Formed to buy, hold, or sell qualifying investment
securities on its own behalf, and capital is primarily derived from investments by entities and persons not affiliated with the
fund.
10. If the taxpayer is an out-of-state entity that will be doing business in Tennessee, does it have a location or office in
Tennessee?
Yes
No
If yes, identify the city and county.
Revenue Use Only: Place Bar Code Here
11. The statements made on this application are true to the best
of my knowledge and belief. (NOTE: This application must
be signed by the individual owner, a member, or partner.)
Sign Here:
(Signature and Date)
INTERNET (9-08)
RV-F1319201 (Rev. 9-08)
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