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Application For Sales And Use Tax Exemption For Nonprofit Organizations - Virginia Department Of Taxation Page 3

Section V - Financial Information

Enter the total dollar amount of the organization’s annual gross revenue (AGR), fundraising expenses, and

administrative cost for the previous year. If you are a new organization and have no financial information at

this time, enter zero(s) in the applicable fields. See page 3 of the instructions.

a) Enter organization’s total annual gross revenue for the previous year. ___________________

b) Enter organization’s total fundraising expenses incurred for the previous year. _____________

c) Enter organization’s total administrative cost for the previous year. ______________________

Section VI - Total Purchases and Sales Made in Virginia

10. Part I: Enter the total dollar amount of taxable purchases to be made in Virginia for the next year, the current

year, and the total taxable purchases made in the preceding year. Do not include the sales tax. Estimates are

acceptable. See pages 3-4 of the instructions.

Annual Purchases Subject to Sales and Use Tax in Virginia

2010

2009

2008

Part II: Enter the total dollar amount of tangible personal property to be sold in Virginia for the next year, the

current year, and the total of tangible personal property sold in preceding year. Do not include the sales tax.

Estimates are acceptable. Failure to provide this information shall be the basis for the Department to refuse to

exempt your organization. See pages 3-4 of the instructions.

Annual Sales Subject to Sales and Use Tax

(Complete only if you are exempt from collecting the sales and use tax on items sold in Virginia).

2010

2009

2008

11. Are you required to file a federal Form 990 or 990 EZ with the IRS? See page 4 of the instructions.

□

YES

If yes, you must attach a copy of the form. If no, please provide the names, addresses and telephone numbers

of only two members of the Board of Directors.

NAME: ________________________________________

POSITION:_____________________________________

ADDRESS:_____________________________________

CITY: _________________STATE:_____ZIP:________

PHONE NUMBER:(____)_________________________

NAME: ________________________________________

POSITION:_____________________________________

ADDRESS:_____________________________________

CITY: _________________STATE:_____ZIP:________

PHONE NUMBER:(____)_________________________

Va. Dept. of Taxation

Rev. (7/1/09)

Page

Application For Sales And Use Tax Exemption For Nonprofit Organizations - Virginia Department Of Taxation Page 3