Form St-130 - Sales Tax Exempt Status Application

Sales Tax Exempt

Status Application

FOR OFFICE USE ONLY

License Number: ____________________________________________________

File Code: E

Approved: ____ Denied: ____ Date: ________________ By: ______________

General Information Required From All Applicants.

1. Full name of organization: ______________________________________________________________________________________

2. Contact person : ______________________________________________________________________________________________

3. Mailing Address: Street or Box Number:____________________________________________________________________________

City:________________________ State:_______ Zip Code:______________ County_______________________________________

4. Federal ID Number:____________________________________________________________________________________________

5. Address of business, if different from No. 3: Street:____________________________________________________________________

City:__________________________________State:___________________Zip Code:____________County:_____________________

6. Business telephone:_________________________________________Contact’s home telephone:______________________________

G Governmental Agency

G Public or Municipal Corporation

7. Type of organization: (check one)

G Relief Agency

G Religious Educational Institution

G Private Educational Institution

8. Will there be more than one location of operation? G Yes

GNo

If yes, how many?___________________

9. Date the organization was formed:_________________________________________________________________________________

10. Date activities began in South Dakota:_____________________________________________________________________________

G Yes

G No

11. Does the organization currently have or ever had a tax license in South Dakota?

If yes, license number(s):________________________________________________________________________________________

Organizational Documents: (These documents will be kept on file with the Department of Revenue)

G1. Bylaws

G2. Articles of Incorporation

G3. Constitution, Articles of Association

G4. If applying for relief agency exemption:

GInternal Revenue Section 501 (C) (3) exemption (Include a copy of IRS Form 1023, App. for Exemption)

G5. If applying for either private or religious educational institution exemption:

GInternal Revenue Section 501 (C) (3) exemption or 501 (D) (Include a copy of the IRS Application for Exemption)

GCertification or Accreditation Approvals

G6. If the organization does not have any of these documents, attach an explanation.

ST-130 3-99

Continue on Reverse Side

Form St-130 - Sales Tax Exempt Status Application - 1999