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Application For Sales And Use Tax Exemption For Nonprofit Organizations - Virginia Department Of Taxation Page 3

Please provide the organization’s annual purchases subject to sales and use tax for this year, next year, and

the preceding year. Estimates are acceptable.

Year / Period

Annual Sales Subject to Sales and Use Tax

2005

2004

2003

11. Are you required to file a federal Form 990 or 990 EZ tax form, or the successor forms, with the IRS?

YES _____

NO ______

If yes, please attach a copy of the form.

If no, please provide the following:

A list of the Board of Directors or other responsible agents of the entity composed of at least two

individuals, with names and addressed where the individuals physically can be contacted.

NAME

ADDRESS

______________________________________

_____________________________________

______________________________________

_____________________________________

12. Is the organization subject to Chapter 5 (§ 57-48 et seq.) of Title 57 of the Code of Virginia, relating to

solicitation of contributions? YES ___NO___ (See page 3 for instructions)

If YES, provide proof of compliance with this chapter.

Proof of compliance shall be documentation, which reflects registration with the

Virginia Department of Agriculture and Consumer Services. Charitable organizations

that intend to solicit contributions within the Commonwealth may be required to

I declare that this organization’s financial records are true, accurate, and complete.

___________________________________________________________ Date __________________

Organization’s Authorized Representative

MAILING INFORMATION: Send completed form with attachments or change of address to:

Virginia Department of Taxation

Office of Customer Services

Non-Profit Exemption Team

Post Office Box 27125

600 East Main Street

Richmond, Virginia 23261-7125

Richmond, Virginia 23219

Fax: 804-786-2645

Application For Sales And Use Tax Exemption For Nonprofit Organizations - Virginia Department Of Taxation Page 3