Form Np-20a - Nonprofi T Application For Sales Tax Exemption
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1Indiana Department of Revenue
NP-20A
Nonprofi t Application for
State Form 51064
(R2 / 10-10)
Sales Tax Exemption
NO FEE REQUIRED.
Part I
Full Name of Organization
This Area for Department Use Only
Type
Street Address
City, State, Zip Code
County
Indiana Taxpayer Identifi cation Number
Federal Identifi cation Number
Date Incorporated
Enter the Month Your
or Formed:
Accounting Period Ends:
What is the predominant purpose of your organization?
Part II
1.
Indicate type of qualifying organization named in I.C. 6-2.5-5-21 (Check only one box in A, B, or C).
A.
Organized specifi cally as a:
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(1) Church
(3) Monastery/Convent
(5) Departmental Use Only
(7) Pension Trust
(2) Hospital
(4) Parochial School
(6) Labor Union
(8) Veteran's Group
B.
Organized and operated for one of the following reasons:
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(1) Religious
(3) Scientifi c
(5) Educational
(7) VEBA
(2) Charitable
(4) Literary
(6) Civic
(8) Student Co-operative Housing
C.
Organized and operated as one of the following entities:
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(1) Fraternal (including fraternal
(2) Departmental Use Only
(4) Business Association
benefi ciary societies)
(3) Business League
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2.
Does your organization sell or rent personal property for more than 30 days in a calendar year?
No
Yes
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3.
Is this organization a local affi liate of a national or parent organization?
No
Yes--If so enter name and address of national or parent
organization.
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4.
Has this organization previously applied for Indiana exempt status?
No
Yes--If so, please indicate previous registration number.
IMPORTANT --Attach the following documents.
Copy of federal determination letter (ruling from the Internal Revenue Service) showing the section of the Internal Revenue Code exemption
from federal tax has been granted. To obtain a copy of federal determination letter or to apply for federal exemption, contact the IRS at:
1-877-829-5500
Mail To:
Indiana Department of Revenue
Tax Administration
P.O. Box 7206
Indianapolis, IN 46207-7206
(317) 232-0129
I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and I have examined this
application, including the accompanying statements, and to the best of my knowledge it is true, correct and complete.
Name of Person(s) to Contact
Daytime Telephone Number(s)
Email Address
Signature
Title
Date Signed
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