Form Rev-956 As - Institution Of Purely Public Charity Renewal Affidavit

ADVERTISEMENT

REV-956 AS (02-09)
INSTITUTION OF
PURELY PUBLIC
CHARITY RENEWAL
Bureau of Business Trust Fund Taxes
PO BOX 280909
AFFIDAVIT
Harrisburg, PA 17128-0909
Organization’s name as shown on the Application for Sales Tax Exemption (REV-72):
Current Exemption Number: 75-
An institution of purely public charity applying for renewal of sales tax-exempt status that completes this affi-
davit will not be required to submit articles of incorporation, by-laws or other governing documents as other-
wise directed on the Application for Sales Tax Exemption.
If the organization is incorporated, the affidavit must be signed by a corporate officer. If not incorporated,
the affidavit must be signed by a responsible party.
INCORPORATED INSTITUTION
Date of Incorporation:
Have the articles of incorporation been amended since the date incorporated?
YES
NO
If yes, date of last amendment(s):
UNINCORPORATED INSTITUTION
Date of Formation:
Have the by-laws been amended since the formation date?
YES
NO
If yes, date of last amendment(s):
NOTE: If the institution has adopted any governance changes after the original filing of the
Application for Sales Tax Exemption (REV-72), or the institution of purely public charity renewal affi-
davit (REVK-1672), then a copy of any amendments must be provided along with a detailed expla-
nation of how such changes affect the Institution.
“Under penalties of perjury, I declare I have examined the above statements and any accompanying documents,
and to the best of my knowledge and belief, all facts relating to this matter contained therein, are true, correct
and complete.”
Name
Signature
Title/Corporate Officer Position
Daytime Phone Number
Date
Street Address
City
State
ZIP Code
Notarization:
Subscribed and sworn before me this ______ day of ______________________ 20 ___ .
My commission expires __________________ , 20 __
Signature of Notary Public

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Institution Of Purely Public Charity Registration Statement Form - Pennsylvania Department Of State Institution Of Purely Public Charity Registration Statement Form - Pennsylvania Department Of State Legal
Application For Institutions Of Purely Public Charity Property Tax Exemption Application For Institutions Of Purely Public Charity Property Tax Exemption Financial
Form Rev-1630a As - Underpayment Of Estimated Tax By Individual Farmers - 2013 Form Rev-1630a As - Underpayment Of Estimated Tax By Individual Farmers - 2013 Financial
Form Rev-1630a As - Underpayment Of Estimated Tax By Individual Farmers - 2012 Form Rev-1630a As - Underpayment Of Estimated Tax By Individual Farmers - 2012 Financial
Form Rev-775 (ex) - Personal Income Tax Employee Business Expense Affidavit Form Rev-775 (ex) - Personal Income Tax Employee Business Expense Affidavit Financial
Form Rev 84 0003e - Mobile Home Real Estate Excise Tax Affidavit Form Rev 84 0003e - Mobile Home Real Estate Excise Tax Affidavit Financial
Form Rev-775 - Pennsylvania Personal Income Tax Employee Business Expense Affidavit Form Rev-775 - Pennsylvania Personal Income Tax Employee Business Expense Affidavit Financial
Form 51a280 (7-13) - Out-of-state Purchase-use Tax Affidavit Form 51a280 (7-13) - Out-of-state Purchase-use Tax Affidavit Financial
Form Ow-15-a - Transmittal Of Nonresident Member Withholding Exemption Affidavit Form Ow-15-a - Transmittal Of Nonresident Member Withholding Exemption Affidavit Financial
Form Rev-1053 As - Schedule Form Rev-1053 As - Schedule "a" Malt Beverage Sales To Distributors Or Customers In Pa (rev-1053) Financial

Related Categories

Parent category: Legal
Download
Go