Form St-Ch-1 - Application For Certificate Of Exemption For Nonprofit Child-Caring Institution, Child-Placing Agency And Maternity Home Every Question Must Be Answered In Full Page 2
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1
2APPLICATION INSTRUCTIONS
1. Provide the legal business name, business location/street address, city, state, and zip code, and telephone number of the child-caring
institution, child-placing agency, or maternity home.
2. Provide the "Doing Business As Name" (d/b/a) (if applicable), mailing address, city, state, and zip code of the child-caring
institution, child-placing agency, or maternity home.
3. Provide the Federal Employer Identification Number, Georgia Withholding Tax Number, and the date the entity first operated in
Georgia.
4. Check the entity type under which this application is being submitted for consideration.
5. Check the type of legal ownership of the child-caring institution, child-placing agency or maternity home.
6. Primary Business Activity: The entity applying for an exemption must complete the expense worksheet and enter the percentage of
expenses derived from the eligible business activity on this line. In order to qualify for the exemption, eligible expenses must exceed
75 percent.
7. Check yes or no if your entity generates sales. If yes, provide a description of the items being sold and the frequency of sales.
8. Check yes or no if you rent or lease real property. If yes, provide the name, address and contact information of the real property
lessor.
9. Check yes or no if licensed by the Georgia Department of Human Resources. If yes, provide a copy of the license.
10. Check yes or no if operating under a nonprofit charter approved by the Internal Revenue Service. If yes, provide a copy of the
Internal Revenue Service's letter of determination.
Primarily Engaged in Providing Child Care Services
Expense Worksheet
O.C.G.A. § 48-8-3(41) provides for a nonprofit child-caring institution, child-placing agency, or maternity home that is primarily engaged
in providing child caring services to be exempt from Georgia sales and use taxes. “Primarily engaged in” is determined by the amount of
eligible expenditures incurred for the child services and activities by the child-caring institution, child-placing agency, or maternity home.
The requirement is deemed to have been met when the eligible expenses incurred exceed 75 percent.
Instructions: Complete all sections.
Section 1. Total expenses of the child-caring institution, child-placing agency, or maternity home.
1. _________________________
Section 2. Identifiable operating expenses attributable to providing child care services.
2. Annualized mortgage or lease payment (Rent)
2. ______________________
3. Playground and classroom equipment
3. ______________________
4. Kitchen appliances and cooking equipment
4. ______________________
5. Other_______________
5. ______________________
6. Other_______________
6. ______________________
7. Total (Lines 2 through 6)
7. ______________________
Section 3. Identifiable annual operating expenses attributable to providing child care services.
8. Salaries and wages
8. ______________________
9. Supplies
9. ______________________
10. Utilities
10. ______________________
11. Other
11. ______________________
12. Total (lines 8 through 11)
12. ______________________
13. Total (Lines 7 and 12)
13. _______________________
14. Enter percentage (Line 13 divided by Line 1)
14. ______________________
The percentage on Line 14 must exceed 75 percent in order to be considered as primarily engaged in providing child care services.
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