Fillable Form Rev-72 - Sales Tax Exemption Application (Page 2 of 12) in pdf

SUBSECTION B – TYPE OF ORGANIZATION

Check the box or fill in the blank to indicate the type of organization that applies to the institution. Examples would include sole

proprietorship, partnership, corporation and association.

Enter the date of incorporation and the state of incorporation. If the institution is not incorporated, enter “N/A.”

Check the box to indicate whether the institution is operated for profit or as a nonprofit organization.

If the institution has applied to and been approved by the IRS as tax-exempt, indicate under which section of the Internal Revenue

Code the institution qualifies. Institutions are under a continuing obligation to immediately notify the PA Department of Revenue if there

is any change in this status. If an institution has not applied with the IRS, enter “N/A.”

All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue any change in

exemption status with the IRS. Institutions are required to report all changes within 10 days in writing to the department. Such changes

include but are not limited to a revocation of the exemption status or receiving an individual exemption where the organization was

previously covered under a group exemption status.

All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue any court decision

that may affect the institution’s tax exemption status. The court decision may be within the state of Pennsylvania or any other

jurisdiction. Institutions are required to report all changes within 10 days in writing to the department.

All institutions are under a mandatory continuing obligation to report to the Pennsylvania Department of Revenue if the organization is

currently being challenged by the IRS, the Commonwealth of Pennsylvania, a political subdivision or any for-profit entity. Institutions are

required to report this information within 10 days in writing to the department.

All correspondence should be mailed to the following address:

PA Department of Revenue

Bureau of Business Trust Fund Taxes

Miscellaneous Tax Division

PO BOX 280909

Harrisburg, PA 17128-0909

SUBSECTION C – ORGANIZATION INFORMATION

All activities carried on by the institution for a period of three years should be reported. This explanation must contain a detailed

description of how the beneficiaries are selected. Additional sheets can be attached to the application, should the response require more

room than the space provided. If bylaws or IRS Form 990 explain the organizational purpose in detail, those documents can be used

to complete this section. Attach any additional documentation such as brochures or pamphlets that explain the institution’s purpose.

SUBSECTION D – AFFILIATE INFORMATION

In this section indicate whether the institution is affiliated with another organization. Affiliate is defined as a domestic or foreign

corporation, association, trust or other organization that owns a 10 percent or greater interest in an institution of purely public charity.

This definition also includes situations where an institution of purely public charity owns a 10 percent or greater interest in a domestic

or foreign corporation, association, trust or other organization.

Please attach an organizational chart to the application.

For a parent institution to be considered an “other nonprofit entity” for purposes of Act 55, all of its subsidiaries must first qualify as

an institution of purely public charity. An organization seeking to qualify as an “other nonprofit entity” is only required to complete

Section 1.

Form Rev-72 - Sales Tax Exemption Application Page 2