Amusement Tax Exemption Registration Form printable pdf download

Amusement Tax Exemption Registration Form

TOWN OF BLOOMSBURG

COLUMBIA COUNTY, PENNSYLVANIA

AMUSEMENT TAX EXEMPTION

REGISTRATION FORM

This form must be submitted once to the Tax Collector of the Town of Bloomsburg at the Bloomsburg

Town Hall, by any organization which intends to claim exemption from amusement tax under Section V.

C of the Amusement Tax Ordinance (Ordinance No. 719), enacted January 8, 1990.

The exemption provided by Section V. C of the Amusement Tax Ordinance is available only to those

organizations of the type listed in Section 501(c)(3) of the United States Internal Revenue Code of 1986,

as amended, contributions to which are tax‐deductible as charitable contributions. If your organization

claims exemption under such provisions, attach a copy of your official, valid Recognition of Exemption

under Section 501 (c) (3) of the Internal Revenue Code, and submit this completed and signed form,

together with said attachment, to the Tax Collector of the Town of Bloomsburg.

Name of Organization: _________________________________________________________________

Address:

_________________________________________________________________

Telephone Number:

_________________________________________________________________

Name of Person Completing this Form: _____________________________________________________

(please print)

Signature: ________________________________________________

Date: ________________________________________________

Amusement Tax Exemption Registration Form