Fillable Form Rev-72 - Sales Tax Exemption Application (Page 4 of 12) in pdf

LINE 3 –

A voluntary agreement is an agreement, contract or other arrangement whereby the institution is making contributions

to a school district, municipality or county government in lieu of taxes. The term voluntary agreement also includes the

establishment of public service foundations by institutions of purely public charity.

If an institution has such an arrangement with local governments, indicate so in the space provided. If an institution has

more than one agreement with different taxing jurisdictions, include the total number of agreements. Each agreement

must be attached to the application.

LINE 4 –

Each person who donates time to the institution should be listed along with the reasonable number of hours per week and

the number of weeks per year. The data must be from the same year as the financial data. Alternatively, the institution

may list the number of individuals who contribute the same number of hours per week and weeks per year. A listing by

names and hours worked should be available for inspection by the department if requested. For example, the institution

may have three volunteers who each contribute three hours for 50 weeks and five volunteers who each contribute five

hours per week for 26 weeks per year. The entry would appear as follows:

NAME OF INDIVIDUAL OR NUMBER OF INDIVIDUALS

HOURS PER WEEK

WEEKS PER YEAR

LINE 5 –

A. This figure represents the total number of individuals currently receiving goods or services from the institution. In

calculating the number of individuals for purposes of this section, educational institutions may include the number of

full-time students as defined by the Department of Education. Supply any documentation that can support this figure.

Examples of this would include children in a little league or patients seen by a hospital.

B. This figure represents total registered members of the organization.

LINE 6 –

This figure represents the number of individuals who are receiving goods or services free. The goods or services provided

must be entirely free. Supply any documentation that can support this figure.

LINE 7 –

This figure represents the number of individuals who pay a fee that is less than the cost the institution incurs in providing

the goods or services. Regardless of the discount given, this figure should represent the total number of individuals who

receive a discount. Do not include in the count the number of individuals who do not pay any fee.

LINE 8 –

Check YES if any of the people who receive goods or services from the organization pay a fee that is equal to or greater

than the cost of the goods or services provided to them.

LINE 9 –

This question considers only those individuals who are receiving financial assistance from the institution. List the number

of individuals who receive financial assistance, such as scholarships, grants, etc., from the institution.

LINE 10 – List the number who receive financial assistance of more than 10 percent of the cost of goods or services that are

provided to them.

Volunteer fire companies and churches should stop here.

PART 2 – RECIPIENT INFORMATION

LINE 1 –

This figure represents the percentage of individuals who receive goods or services from the institution who pay a fee

that is at least 10 percent lower than the cost of the goods or services they receive. Supply any documentation that can

support this figure.

LINE 2 –

This figure should represent the cost the institution incurs in providing community services. Supply any documentation

that can support this figure.

LINE 3 –

This figure should represent the payments the institution receives for providing community services. Supply any

documentation that can support this figure.

LINE 4 –

This figure should represent the cost the institution incurs in providing education and research programs. Supply any

documentation that can support this figure.

Form Rev-72 - Sales Tax Exemption Application Page 4

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