Form Rev-72 - Sales Tax Exemption Application Page 8
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12APPLICATION FOR
SALES TAX EXEMPTION
SUBSECTION C – ORGANIZATION INFORMATION
PROVIDE A DETAILED DESCRIPTION OF THE PAST, PRESENT AND PLANNED FUTURE ACTIVITIES OF THE INSTITUTION FOR A PERIOD
OF THREE YEARS. INCLUDE A DESCRIPTION OF HOW BENEFICIARIES ARE SELECTED.
SUBSECTION D – AFFILIATE INFORMATION
ARE YOU A NONPROFIT PARENT CORPORATION THAT ELECTS TO BE CONSIDERED AS A
SINGLE INSTITUTION IN CONJUNCTION WITH YOUR SUBSIDIARY, WHICH IS AN INSTITUTION
o
o
OF PURELY PUBLIC CHARITY?
YES
NO
o
o
ARE YOU AFFILIATED WITH ANOTHER ORGANIZATION?
YES
NO
LIST EACH AFFILIATE, ITS ADDRESS, THE DATE OF AFFILIATION/SUBSIDIARY, PERCENT OF OWNERSHIP IN EACH, THE TYPE OF
INSTITUTION, THE RELATIONSHIP AND WHETHER IT IS ORGANIZED AS A FOR-PROFIT OR NONPROFIT INSTITUTION. ATTACH
ADDITIONAL SHEETS IF NECESSARY OR AN ORGANIZATIONAL CHART.
NAME OF AFFILIATE
FEDERAL EIN
PERCENT OF OWNERSHIP
ADDRESS
DATE OF AFFILIATION
TYPE OF ORGANIZATION
RELATIONSHIP
PROFIT OR NONPROFIT
NAME OF AFFILIATE
FEDERAL EIN
PERCENT OF OWNERSHIP
ADDRESS
DATE OF AFFILIATION
TYPE OF ORGANIZATION
RELATIONSHIP
PROFIT OR NONPROFIT
SUBSECTION E – OFFICER INFORMATION
THIS SECTION MUST BE COMPLETED IN FULL BY EVERY INSTITUTION, EVEN IF THE INSTITUTION DOES NOT COMPENSATE ITS
OFFICERS. THE ANNUAL COMPENSATION SHOULD INCLUDE THE OFFICER’S SALARY FROM THE INSTITUTION, CONTRIBUTIONS MADE
ON THE OFFICER’S BEHALF TO EMPLOYEE BENEFIT PROGRAMS AND DEFERRED COMPENSATION, EXPENSE ACCOUNT AND ANY OTHER
FORM OF COMPENSATION. ATTACH ADDITIONAL SHEETS IF NECESSARY. IRS FORM 990 MAY BE SUBSTITUTED.
LAST NAME
FIRST NAME
TITLE
ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
TITLE
ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
TITLE
ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
TITLE
ANNUAL COMPENSATION
OTHER BENEFITS AND AMOUNTS OF EACH
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