Form Np1 - Sales And Use Tax - Virginia Department Of Taxation Page 3
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4Section V - Financial Information
9.
Enter the total dollar amount of the organization’s annual gross revenue (AGR), fundraising expenses, and
administrative expenses for the previous year. If you are a new organization and have no financial information
at this time, enter zero(s) in the applicable fields. If the annual gross revenue is less than $5,000, you must
attach a copy of the organizations mission statement or statement of purpose. See page 5 of the instructions.
a) Enter organization’s total annual gross revenue for the previous year. $___________________
b) Enter organization’s total fundraising expenses incurred for the previous year. $_____________
c) Enter organization’s total administrative expenses for the previous year. $______________________
Section VI - Total Purchases Made in Virginia
10. Does the organization intend to make purchases in Virginia? See pages 5-6 of the instructions.
Please select one:
□
□
YES
NO
a). If yes, enter an estimate of the dollar amount of Virginia purchases made in the preceding year and those made
or to be made in the current year. Please allocate the purchases as accurately as possible in the regions
provided below. Do not include the sales tax. Enter zero if no purchases were made.
Virginia Regions
Total Purchases - 2015
Total Purchases - 2016
Northern Virginia Region: Alexandra City,
Arlington County, Fairfax City, Fairfax County,
Falls Church City, Loudon County, Manassas City,
Manassas Park City, Prince William County
Hampton Roads Region: Chesapeake City, Franklin City,
Hampton City, Isle of Wight County, James City County,
Newport News City, Norfolk City, Poquoson City, Portsmouth
City, Southampton County, Suffolk City, Virginia Beach City,
Williamsburg City, York County
Elsewhere throughout Virginia
NOTE: Failure to provide this information may result in the denial of the exemption request.
b). If no, please provide a brief explanation why the organization is requesting an exemption but have no plans to
make purchases in Virginia.
11. Are you required to file a federal Form 990, 990-EZ, 990-PF, or 990-N with the IRS? See page 6 of the
instructions.
□
□
YES
NO
a). If yes, enter the due date of the most recent filed return or if you are newly organized, enter the date the return is
due. (MM/DD/YY) ___________________ You may be asked to provide a copy of the federal form filed by
the organization.
b). If no, please provide the names, addresses and telephone numbers of two members of the Board of Directors and
submit a copy of the organization’s prior year’s financial statement.
1. NAME: _______________________________
2
NAME: _______________________________
TITLE: _______________________________
TITLE: _______________________________
ADDRESS: ____________________________
ADDRESS: ____________________________
CITY: ________________________________
CITY: ________________________________
STATE: _____
STATE: _____
ZIP: __________
ZIP: __________
PHONE NUMBER: (____)________________
PHONE NUMBER: (____)________________
Va. Dept. of Taxation
Rev. (2/11/2014)
Page
3
FAX NUMBER: (____)___________________
FAX NUMBER: (____)___________________
6210202
EMAIL ADDRESS: _____________________
EMAIL ADDRESS: _____________________
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