Form Rp-420-A-Org - Application For Real Property Tax Exemption For Nonprofit Organizations - Mandatory Class I-Organization Purpose Page 3

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RP-420-a-Org (9/08)
3
a. Date incorporated ____________________ b. State/County in which incorporated
c. Under which law? Law: ________________________ Article or section:
ATTACH COPY OF CURRENT ARTICLES OF INCORPORATION (Note: If a dissolution provision is
not included in the articles, also attach a statement describing how assets would be distributed should the
organization dissolve.)
d. Form of organization
e. Date formed
f. Has the organization applied for incorporation?
Yes
No - If no, skip to question 6. If yes:
(1) State/County in which application has been filed
(2) Under which Law? Law: ___________________________ Article or section:
(3) Date application filed: _________________________________
ATTACH COPY OF APPLICATION AND CONSENTS REQUIRED WITH APPLICATION
ATTACH COPY OF CURRENT ARTICLES OF ORGANIZATION (Note: If a dissolution
provision is not included in the articles, also attach a statement describing how assets would be distributed
should the organization dissolve.)
6. Is the organization under the supervision of any public regulatory body?
Yes
No
If yes, answer a through c.
a. Which one(s)? Give name and address
b. Does the organization have an operating certificate, permit, charter, or similar authorization issued
by a public regulatory body?
Yes
No
IF YES, ATTACH COPY OF AUTHORIZATION
c. Does the organization solicit contributions from the public?
Yes
No
If yes and the organization is registered with the Attorney General’s Charities Bureau, give the
organization’s registration number
Clear Form
VERIFICATION
State of New York
ss:
County of
______________________, being duly sworn, says that __he is the
of
the applicant organization, that the statements contained in this application (including the attached
sheets consisting of ____ pages) are true, correct and complete, and that __he makes this application
for real property tax exemption as provided by law.
Subscribed and sworn to before me
this _____ day of ________________, 20__
Signature of owner or authorized representative
Commissioner of deeds or notary public

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