Fillable Form Rev-72 - Sales Tax Exemption Application (Page 6 of 12) in pdf

Form Rev-72 - Sales Tax Exemption Application Page 6

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LINE 12 – Check YES if the institution is licensed by the Department of Health or the Department of Public Welfare.

Attach a list showing the reasonable amount that the institution receives or donates to other charitable organizations in

the form of contributions. The lists should be broken out according to each organization and the amount donated or

received from each. Supply any documentation that can support this figure.

PART 4 – FUNDRAISING ACTIVITIES

LINE 1 –

This question asks whether the institution operates to fund raise on behalf of or supply grants to another organization.

This other organization must be an institution of purely public charity, an entity similarly recognized by another state or

foreign jurisdiction, a qualifying religious organization or a government agency. The institution must make an actual

contribution of a substantial portion of the funds it raises to the organization. A listing of the organizations who receive

the contributions and the amount donated to each organization must accompany the application.

SUBSECTION D – AUTHORIZED SIGNATURE

SIGNATURE OF

The application must be signed by a corporate officer who is responsible for the information

CORPORATE OFFICER:

provided. Enter the title of the person who signed the form. If not incorporated, the application should

be signed by a responsible party.

TYPE OR PRINT NAME:

Type or print name of the person who signed, the date the form was signed and a daytime telephone

number.

PREPARER’S NAME:

Type or print name of the preparer, the date, the preparer’s daytime telephone number and title.

MAIL COMPLETED

APPLICATION TO:

PA DEPARTMENT OF REVENUE

BUREAU OF BUSINESS TRUST FUND TAXES

MISCELLANEOUS TAX DIVISION

PO BOX 280909

HARRISBURG, PA 17128-0909

(717) 783-5473

TT# 1-800-447-3020 (Services for taxpayers with special hearing

and/or speaking needs)

Form Rev-72 - Sales Tax Exemption Application Page 6

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