New York State Department of Taxation and Finance
CT-247
Application for Exemption from Corporation Franchise
(8/12)
Taxes by a Not-for-Profit Organization
Legal name of corporation
Employer identification number
For office use only
Mailing name (if different from legal name)
c/o
Number and street or PO box
City
State
ZIP code
Principal business activity
Date tax exemption claimed from
For audit use only
Form of organization
Business/officer telephone number
(mark an X in the appropriate box)
Corporation
Association
Trust
Other
(
)
Date of formation
State or country of incorporation
Taxable
Exempt
Indicate exact name of the law under which the entity was formed (general corporation, not-for-profit, membership, etc.). Cite statutory provisions.
Federal return was filed on
:
Form 990
Form 990‑T
Form 1120
Other:
(mark an X in one)
For lines 1 through 7, mark an X in the Yes or No box
1 Is the entity organized and operated as a not‑for‑profit organization? ...................................................................... Yes
No
2 Is the entity authorized to issue capital stock?
.............................. Yes
No
(If Yes, also mark an X in the appropriate box below.)
Title holding company
Collective investment
Other:
List shareholders:
3 Does any part of the net earnings of the organization benefit any officer, director, or member? .............................. Yes
No
4 Does the entity meet the qualifications for exemption from federal income tax?
........................ Yes
No
(See General information)
If No, stop. You do not qualify as an exempt organization.
5 Did the entity apply for federal exemption? ............................................................................................................... Yes
No
If Yes, indicate date of exemption
. Attach a copy of your federal exemption letter.
6 Is the entity engaged in an unrelated business activity at a location in New York State? ......................................... Yes
No
7 Is the entity operating as a trust under Internal Revenue Code (IRC) section 401(a) and exempt from federal
income tax under IRC section 501(a)? .................................................................................................................. Yes
No
8 List location and type of activity for each office and other places of business
(attach separate sheet if necessary).
Location
Nature of activity
9 List officers, employees, agents, and representatives in New York State and briefly describe their duties
(attach separate sheet if necessary).
Name
Title
Duties
10 List type and use of real property owned in New York State (
attach separate sheet if necessary).
Type
How used
11 Describe any New York State activities not shown above (
attach separate sheet if necessary).
Certification: I certify that this application and any attachments are to the best of my knowledge and belief true, correct, and
complete. Willfully filing a false application is a misdemeanor punishable under the Tax Law.
Printed name of authorized person
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Telephone number
Date
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
Paid
(or yours if self-employed)
preparer
Signature of individual preparing this application
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this application
Preparer’s NYTPRIN
Date
(see instr.)