Form Rev-72 - Sales Tax Exemption Application Page 9
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12APPLICATION FOR
SALES TAX EXEMPTION
SUBSECTION F – SALARY INFORMATION
All organizations must complete this information.
o
o
IS COMPENSATION BASED IN ANY WAY ON THE FINANCIAL PERFORMANCE OF THE INSTITUTION?
YES
NO
IF YES, PLEASE EXPLAIN ON A SEPARATE SHEET AND ATTACH IT TO THE APPLICATION.
DOES THE ORGANIZATION APPLY ALL REVENUE, LESS EXPENSES, FOR THE FURTHERANCE
o
o
OF ITS CHARITABLE PURPOSE?
YES
NO
DO ANY OF THE INSTITUTION’S NET EARNINGS OR DONATIONS THAT IT RECEIVES INURE TO
o
o
THE BENEFIT OF PRIVATE SHAREHOLDERS OR INDIVIDUALS?
YES
NO
LIST POSITION, SALARY AND OTHER COMPENSATION, INCLUDING BENEFITS, OF THE FOUR HIGHEST PAID INDIVIDUALS. DO NOT
REPEAT THOSE OFFICERS LISTED IN SUBSECTION E (OFFICER INFORMATION). INDICATE IN THE SPACE ALLOTTED BELOW A STATE-
MENT INDICATING THE BASIS OF COMPENSATION. IF THE INSTITUTION IS COMPRISED ONLY OF VOLUNTEERS, SKIP THIS SECTION
BY WRITING “NOT APPLICABLE”. IF SCHEDULE A IS COMPLETED, IRS FORM 990 SCHEDULE A MAY BE SUBSTITUTED.
LAST NAME
FIRST NAME
POSITION
SALARY
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
POSITION
SALARY
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
POSITION
SALARY
OTHER BENEFITS AND AMOUNTS OF EACH
LAST NAME
FIRST NAME
POSITION
SALARY
OTHER BENEFITS AND AMOUNTS OF EACH
SECTION 2 – FINANCIAL DATA
PLEASE REFER TO THE INSTRUCTIONS BEFORE COMPLETING THIS SECTION.
INDICATE THE YEAR FROM WHICH FINANCIAL DATA WAS USED:
PART 1 – BASIC QUESTIONS
(1) INCOME – LIST ALL OF THE SOURCES OF INCOME, INCLUDING CONTRIBUTIONS, RECEIVED AS PART OF THE INSTITUTION’S
CHARITABLE PURPOSE. EXAMPLE CATEGORIES ARE LISTED. ADDITIONAL SOURCES SHOULD BE LISTED AND IDENTIFIED UNDER
“OTHER”. ATTACH ADDITIONAL SHEETS IF NECESSARY.
ACTIVITY
DOLLAR AMOUNT
CONTRIBUTIONS & DONATIONS
FEES RECEIVED FOR GOODS OR SERVICES
FEE-FOR-SERVICE PAYMENTS FOR ANY GOVERNMENTAL PROGRAMS
GOVERNMENT SUPPORT (ie. GRANTS, FUNDING, etc.)
OTHER, LIST:
TOTAL REVENUE
(INCLUDING AMOUNTS LISTED
ON SEPARATE SHEETS)
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