Form Rev-72 - Sales Tax Exemption Application Page 11
Download a blank fillable Form Rev-72 - Sales Tax Exemption Application in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Rev-72 - Sales Tax Exemption Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12APPLICATION FOR
SALES TAX EXEMPTION
(4)
WHAT IS THE COST OF PROVIDING EDUCATION AND RESEARCH PROGRAMS PROVIDED
BY OR PARTICIPATED IN BY THE INSTITUTION? ATTACH A COPY OF SUPPORTING
DOCUMENTATION TO THE APPLICATION.
(5)
WHAT AMOUNT DOES THE INSTITUTION RECEIVE AS PAYMENT TO SUPPORT ITS
EDUCATION AND RESEARCH PROGRAMS? ATTACH A COPY OF SUPPORTING
DOCUMENTATION TO THE APPLICATION.
(6)
(A) DOES THE INSTITUTION PROVIDE GOODS OR SERVICES TO INDIVIDUALS
WITH MENTAL RETARDATION OR TO INDIVIDUALS WHO NEED MENTAL
o
o
HEALTH SERVICES?
YES
NO
(B) DOES THE INSTITUTION PROVIDE GOODS OR SERVICES TO MEMBERS OF AN
o
o
INDIVIDUAL’S FAMILY OR GUARDIAN IN SUPPORT OF SUCH GOODS OR SERVICES?
YES
NO
(C) DOES THE INSTITUTION PROVIDE GOODS OR SERVICES TO INDIVIDUALS WHO
ARE DEPENDENT, NEGLECTED OR DELINQUENT CHILDREN THAT WOULD
o
o
OTHERWISE BE THE GOVERNMENT’S RESPONSIBILITY TO PROVIDE?
YES
NO
IF THE RESPONSE TO ANY OF THE ABOVE THREE QUESTIONS IS YES, ANSWER THE FOLLOWING QUESTIONS. OTHERWISE, SKIP TO
PART 3. DO ANY OF THE FOLLOWING STATUTES OR REGULATIONS GOVERN THE INSTITUTION’S ABILITY TO RETAIN REVENUE OVER
EXPENSES OR VOLUNTARY CONTRIBUTION?
o
o
(A) SECTION 1315(C) AND 1905(D) OF THE SOCIAL SECURITY ACT.
YES
NO
o
o
(B) 42 CFR 440.150 (RELATING TO INTERMEDIATE CARE FACILITY SERVICES)
YES
NO
(C) 42 CFR PT 483 SUBPART I (RELATING TO CONDITIONS OF PARTICIPATION FOR
o
o
INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED)
YES
NO
(D) THE ACT OF OCT. 20, 1966 (MENTAL HEALTH AND MENTAL RETARDATION
o
o
ACT OF 1966)
YES
NO
(E) ARTICLES II, VII, IX AND X OF THE ACT OF JUNE 13, 1967 KNOWN AS THE
o
o
PUBLIC WELFARE CODE
YES
NO
o
o
(F) 23 PA.C.S. CH. 63 (RELATING TO CHILD PROTECTIVE SERVICES)
YES
NO
o
o
(G) 42 PA.C.S. CH. 63 (RELATING TO JUVENILE MATTERS)
YES
NO
o
o
(H) 55 PA CODE CHS 3170 (RELATING TO ALLOWABLE COSTS AND PROCEDURES FOR
YES
NO
COUNTY CHILDREN AND YOUTH), 3680 (RELATING TO ADMINISTRATION AND
OPERATION OF A CHILDREN AND YOUTH SOCIAL SERVICE AGENCY), 4300 (RELATING
TO COUNTY MENTAL HEALTH AND MENTAL RETARDATION FISCAL MANUAL), 6400
(RELATING TO COMMUNITY HOMES FOR INDIVIDUALS WITH MENTAL RETARDATION),
6500 (RELATING TO FAMILY LIVING HOMES), 6210 (RELATING TO PARTICIPATION
REQUIREMENTS FOR THE INTERMEDIATE CARE FACILITIES FOR THE MENTALLY
RETARDED PROGRAM), 6211 (RELATING TO ALLOWABLE COST REIMBURSEMENT
FOR NON-STATE OPERATED INTERMEDIATE CARE FACILITIES FOR THE MENTALLY
RETARDED) AND 6600 (RELATING TO INTERMEDIATE CARE FACILITIES FOR THE
MENTALLY RETARDED)
PART 3 – GOODS OR SERVICES PROVIDED
(1)
WHAT IS THE COST OF ALL GOODS OR SERVICES PROVIDED BY THE INSTITUTION FOR WHICH
IT HAS NOT RECEIVED MONETARY COMPENSATION? THIS FIGURE SHOULD NOT INCLUDE
BAD DEBTS OR ACCOUNTS REPORTED AS UNCOLLECTIBLE.
(2)
IF THE INSTITUTION RECEIVES A LESSER FEE THAN THE FULL COST ASSOCIATED WITH
PROVIDING GOODS OR SERVICES, INDICATE WHAT THE DIFFERENCE BETWEEN THE FULL
COST AND THE AMOUNT RECEIVED AS COMPENSATION.
(3)
IF THE INSTITUTION CHARGES A FEE TO INDIVIDUALS PURCHASING ITS GOODS OR SERVICES,
WHAT IS THE COST FOR THOSE GOODS OR SERVICES RENDERED TO INDIVIDUALS WHOSE
ACCOUNTS ARE DEEMED UNCOLLECTIBLE?
(4)
DOES THE INSTITUTION HAVE A PUBLISHED WRITTEN POLICY STATING THAT GOODS OR SERVICES
o
o
WILL BE PROVIDED TO ALL WHO SEEK THEM WITHOUT REGARD TO THEIR ABILITY TO PAY?
YES
NO
(5)
DOES THE INSTITUTION HAVE A WRITTEN POLICY STATING THAT GOODS OR SERVICES WILL
o
o
BE PROVIDED FOR A FEE BASED UPON THE RECIPIENT’S ABILITY TO PAY FOR THEM?
YES
NO
11
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial