Instructions for Form ST-119.2 ST-119.2-I (12/13) Application for an Exempt Organization Certificate Read these instructions carefully and complete all applicable sections on to make our determination. If the person is someone other than a trustee the form. We cannot process an incomplete application. or officer of the organization, this application must be accompanied by a power of attorney executed by an authorized officer before we can Note: In addition to applying for an Exempt Organization Certificate to provide any information on the status of the application to the contact make exempt purchases, if your organization makes sales through a person. Use Form ST-119.4, Application for an Exempt Organization shop or store, or a restaurant, tavern, or other similar establishment, Certificate Power of Attorney. it must register for sales tax purposes and collect and remit sales tax. Also, your organization must register for sales tax purposes and collect If unincorporated, enter the date organized (i.e., the date that the and remit sales tax if it makes any of the following sales, whether or not organizing documents were formally adopted). If incorporated, enter made from a shop or store: the date the articles of incorporation were filed with the appropriate • any lease or rental of tangible personal property; government agency. • any utility service described in Tax Law section 1105(b); Enter your federal employer identification number. (This number is not • any service to real property described in Tax Law section 1105(c)(5); and proof of federal exemption as required on lines 8 and 9 below.) • Line 1a – Mark an Xin the box on line 1a and any applicable additional any tangible personal property where the sale is made by remote means, such as by telephone, mail order (including email), over the boxes to indicate the purpose for which you are claiming exempt status Internet, or by other similar methods, provided the sales are made if you are applying under Tax Law section 1116(a)(4). In addition to being with a degree of regularity, frequency, and continuity. organized for one or more of the listed activities, you must meet the • Also, if the organization sells parking services or operates a hotel or following requirements: makes amusement charges, it must register for sales tax purposes • No part of the organization’s net income can benefit private and collect and remit tax. shareholders or individuals. • To register for sales tax purposes, visit the New York Business • The organization cannot, as a substantial part of its activities, attempt Express at www.businessexpress.ny.gov to obtain a Certificate of to influence legislation. (If you have established federal exemption Authority. under Internal Revenue Code (IRC) section 501(c)(3), that section will govern the extent of legislative activities permissible. If not, the Tax Who should file this form Department will make the determination.) An organization described in Tax Law section 1116(a)(4), 1116(a)(5), • The organization cannot participate, directly or indirectly, in political 1116(a)(7), 1116(a)(8), or 1116(a)(9), should file Form ST-119.2 to apply campaigns for or against candidates for public office. for an Exempt Organization Certificate. If the Tax Department issues • The organization’s assets must be dedicated to its exempt purposes. you an Exempt Organization Certificate, you may make tax-exempt If it is dissolved or terminated, the assets must be distributed to purchases. further one or more exempt purposes or to a federal, state, or local government for a public purpose. Agencies of the United States and of New York State and its political subdivisions should not use this form. They may make tax-free • If organized to foster national or international amateur sports purchases by presenting vendors with governmental purchase orders. competition, the organization may not provide athletic facilities or equipment unless it is an amateur sports organization organized and Units of the Boy Scouts of America and the Girl Scouts of the USA operated primarily to support and develop amateur athletes for, or to should contact their local councils for the procedures they must follow to conduct, national or international sports competition. establish sales tax exemption. Line 1b – Mark an Xin the box and indicate the percentages of each New York State Tax Law does not provide sales tax exemptions to other type of member if you are applying under Tax Law section 1116(a)(5). states or their political subdivisions. At least 75% of the organization’s membership must fall within the first category listed. In addition, you must be organized in New York Where to file State, and no part of the organization’s earnings can benefit private Mail your completed application and all attachments to: shareholders or individuals. NYS TAX DEPARTMENT Auxiliary units, societies of, or trusts or foundations for posts or SALES TAX EXEMPT ORGANIZATIONS UNIT organizations may also qualify as exempt organizations if they show W A HARRIMAN CAMPUS that they were created by and are affiliated with an organization ALBANY NY 12227 already exempted by the Tax Department. Attach a copy of the federal determination letter confirming your IRC section 501(c)(19) exemption. Refunds for sales tax previously paid Mark an X in the box and attach a copy of your federal or New Once you establish your exempt status, you may be entitled to a Line 1e – York State charter if you are applying under Tax Law section 1116(a) refund of sales tax you previously paid if you met the requirements for (9). Note: Effective March 1, 2008, all state-chartered credit unions, as exemption when the purchases were made. However, if you had to defined by New York State Banking Law section 2(9), will be exempt amend documents or change operations to qualify for exemption, you from sales tax, regardless of when they were chartered. (For more are not entitled to a refund of taxes paid before the effective date of the information regarding credit unions designated as exempt organizations, change. see TSB-M-06(4)S, Credit Unions Designated as Exempt Organizations Use Form AU-11, Application for Credit or Refund of Sales or Use Tax, for Sales and Use Tax Purposes.) to request a refund. Keep sales slips and invoices to support your claim. Lines 3 through 6 – Answer the questions on lines 3 through 6 by Refunds are generally subject to a three-year statute of limitations. marking an Xin the applicable boxes. Answering Yes to a question will not necessarily disqualify you, but you must attach an explanation. Specific instructions Enter all applicable information and attach the requested documents. Line 7 – If you answer Yes, attach an explanation of how you meet the Documents submitted with this application will not be returned, so be criteria of a qualified amateur sports organization as defined in Tax Law sure to keep copies. section 1116(f). Enter the organization’s legal name (as it appears in its organizing Line 8 – Mark an Xin the Yes box and attach a copy of the federal documents), telephone number, physical address, and mailing address. determination letter confirming your IRC section 501(c)(3) exemption if your organization has been granted exemption in its own name under Enter the name, title, telephone number, email address, and fax number IRC section 501(c)(3). No other documentation is needed; however, of the person to contact if we need more information or documentation we reserve the right to request any additional information necessary to make our determination. |
Page 2 of 2 ST-119.2-I (12/13) Line 9 – Mark an Xin the Yes box if you are a subunit of an organization Statement of assets and liabilities that has a group IRC section 501(c)(3) exemption. Attach a copy of the As of December 1, XXXX federal determination letter confirming your 501(c)(3) exemption and one of the following: Assets: • a current letter from the “parent” organization certifying that the Cash on hand: $ 200.00 subunit is a member of the organization and is included under the Cash in bank: 1,500.00 federal 501(c)(3) exemption, or Investments: Stock 10 @ $50.00 500.00 Office supplies and equipment 300.00 • a copy of the “parent” organization’s directory of subunits that lists this Buildings 20,000.00 subunit as one of those covered by the federal exemption. Land: 5 acres 2,000.00 If your organization has been granted federal exemption under some Other assets: other IRC section, attach a copy of the federal determination letter Bus 600.00 confirming your exemption. All attachments are required. Total assets $25,100.00 If there is a discrepancy between the name and address as it appears on Liabilities: the federal determination letter and on this application, please explain. Accounts payable $ 00.00 Loans payable: Bank of NY 500.00 Line 10 – To qualify for exempt status, you must be formally Mortgage payable: 10,000.00 organized to conduct exempt activities and you must have organizing Other liabilities: documents specifying the activities. Mark an Xin the appropriate box Electric bill 60.00 to indicate your type of organization and attach copies of the required Total liabilities $10,560.00 organizing documents including any amendments to them (if you are attaching a copy of the federal determination letter confirming your Signature – An officer of the organization must sign and date this IRC section 501(c)(3) exemption, you need not attach the organizing application. Be sure you have completed all applicable entries and documents). Note that these documents cannot be returned. included true copies of all required documents. We will return any Line 11 – You must also attach the following to your application (unless incomplete applications to you. Keep copies of your application and all you are attaching a copy of the federal determination letter confirming attachments. your IRC section 501(c)(3) exemption as previously noted): • Statement of activities – Describe your present and future activities in detail. Do not use general statements or repeat the language of your Need help? organizing documents. If you are not fully operational, explain what stage of development you have reached, what remains to be done, Visit our Web site at www.tax.ny.gov and when you will be fully operational. • get information and manage your taxes online • Statement of receipts and expenditures • check for new online services and features • Statement of assets and liabilities – Assets are all real and personal property; liabilities are all outstanding debts, of any nature. Telephone assistance If you do not have formal financial statements, you may use the following examples as a guide. Bank statements, copies of receipts, Sales Tax Information Center: (518) 485-2889 invoices, and journal or ledger sheets are not acceptable substitutes. To order forms and publications: (518) 457-5431 Examples: Text Telephone (TTY) Hotline (for persons with Name of Organization hearing and speech disabilities using a TTY): (518) 485-5082 Statement of receipts and expenditures January 1, XXXX, through December 31, XXXX Persons with disabilities: In compliance with the Americans with Disabilities Act, we will ensure that our Receipts: lobbies, offices, meeting rooms, and other facilities are Dues: membership 50 @ $2.00 $ 100.00 accessible to persons with disabilities. If you have questions Contributions: about special accommodations for persons with disabilities, call the Voluntary contributions from members 500.00 information center. Contributions from the public 1,000.00 Funding: Privacy notification Department of Recreation 1,000.00 HUD 500.00 The Commissioner of Taxation and Finance may collect and maintain (submit copies of pertinent contracts) personal information pursuant to the New York State Tax Law, including Receipts from fund-raising activities: but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, Bake sale 150.00 1096, 1142, and 1415 of that Law; and may require disclosure of social Dinner dance tickets 600.00 security numbers pursuant to 42 USC 405(c)(2)(C)(i). Total receipts $3,850.00 This information will be used to determine and administer tax liabilities and, when authorized by law, for certain tax offset and exchange of tax Expenditures: information programs as well as for any other lawful purpose. Fund-raising expenses Bank, advertising, food $ 300.00 Information concerning quarterly wages paid to employees is provided Contributions to: to certain state agencies for purposes of fraud prevention, support Jonesville Fire Co. 50.00 enforcement, evaluation of the effectiveness of certain employment and St. Lukes Church 25.00 training programs and other purposes authorized by law. Operating expenses: Failure to provide the required information may subject you to civil or Electricity 600.00 criminal penalties, or both, under the Tax Law. Telephone 200.00 Fire insurance 300.00 This information is maintained by the Manager of Document Miscellaneous 50.00 Management, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone (518) 457-5181. Total expenditures $1,525.00 Name of Organization |
New York State and Local Sales and Use Tax ST-119.2 Application for an Exempt (9/11) Organization Certificate State and Local Sales and Use Tax Name of organization Organization’s telephone number ( ) Physical address (number and street) City State ZIP code Mailing address City State ZIP code Name and title of person to be contacted (see instructions) Contact person’s telephone number ( ) Email address of person to be contacted Contact person’s fax number ( ) Date formally organized Date incorporated Federal employer identification number Mark an Xin the appropriate box to indicate the Tax Law section under which you are claiming exempt status. 1a Section 1116(a)(4) – Mark an Xin the appropriate box to indicate the purpose for which you are claiming exempt status (see instructions). Religious Testing for public safety Prevention of cruelty to children or animals Charitable Scientific Fostering national or international amateur sports competition Educational Literary 1b Section 1116(a)(5) – A post or organization organized in New York State of past or present members of the United States armed forces, or an auxiliary unit or society of, or a trust or foundation for, any such post or organization organized in New York State (see instructions). What percentage of your members are past or present members of the United States armed forces? ........ % What percentage of your members are cadets or are spouses, widows, widowers, ancestors, or lineal descendants of past or present members of the United States armed forces or of cadets? ...................... % What percentage of your members do not fall within either of the above categories? ................................... % If the post or organization has received a federal ruling on its exemption claim, attach a copy of the federal determination letter confirming your Internal Revenue Code (IRC) section 501(c)(19) exemption. 1c Section 1116(a)(7) – A not-for-profit corporation acting as a health maintenance organization subject to the provisions of Public Health Law Article 44. You must attach a copy of the certificate of authority issued by the New York State Health Department. 1d Section 1116(a)(8) – A cooperative or foreign corporation doing business in this state pursuant to the Rural Electric Cooperative Law. 1e Section 1116(a)(9) – A credit union, as defined by New York State Banking Law section 2(9), where it is the purchaser, user, or consumer of services or property, or where it is a vendor of services or property of a kind not ordinarily sold by private persons (see instructions). 2 Are you currently registered for sales tax purposes with the Tax Department? ................................................. Yes No If Yes, enter your sales tax Certificate of Authority number . If you answer Yes to questions 3 through 7, attach an explanation (see instructions). 3 Has any distribution of the organization’s property ever been made to shareholders, members, or other individuals? ...................................................................................................................................................... Yes No 4 Does any part of the net earnings of the organization go to the benefit of any private shareholder or individual? .... Yes No 5 If you marked box 1a, has the organization ever attempted to influence legislation? ........................................ Yes No |
ST-119.2 (9/11) (back) 6 If you marked box 1a, has the organization ever participated or intervened, directly or indirectly, in any political campaign or endorsed or opposed any candidate for public office? ................................................ Yes No 7 If you marked box 1a and the organization fosters national or international amateur sports competition, does it provide any facilities or equipment, either directly or indirectly, to anyone? ....................................... Yes No 8 Has the organization received an exemption from federal income tax under IRC section 501(c)(3)? ................. Yes No (If Yes, you must attach a copy of the federal determination letter confirming your IRC section 501(c)(3) exemption.) 9 If you are a branch or chapter, has your parent organization received an exemption from federal income tax under IRC section 501(c)(3) that applies to subordinate branches or chapters (see instructions)? ........... Yes No (If Yes, you must attach a copy of the federal determination letter confirming your IRC section 501(c)(3) exemption.) 10 Mark an Xin the appropriate box to indicate your type of organization (see instructions). Corporation (attach a copy of articles of incorporation, including filing receipt, and bylaws and any amendments to either of them) Trust or foundation (attach a copy of Declaration of Trust and bylaws and any amendments to either of them) Limited liability company (LLC) (attach a copy of articles of organization and operating agreement and any amendments to either of them) Credit union (attach a copy of federal or New York State charter) Other (attach a copy of constitution and bylaws and any amendments to either of them) 11 Attach the following to this application (see instructions): • Statement of activities fully describing all current and proposed activities. • Statement of receipts and expenditures for your most recent fiscal year of operation, clearly reflecting the nature and amount of receipts and the purpose and amount of expenditures. (If you have been in existence less than a year, submit a statement of your receipts and expenditures to date, and a proposed budget for the rest of the year.) • Statement of assets and liabilities as of the end of your most recent fiscal year. (If you have been in existence less than a year, your statement should be as of the date of this application). • Note: Do not attach federal Form 1023, Application for Recognition of Exemption. • Note: The Tax Department may require the applicant to submit additional documents and information. Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these statements with the knowledge that willfully providing false or fraudulent information with this document may constitute a felony or other crime under New York State Law, punishable by a substantial fine and possible jail sentence. I also understand that the Tax Department is authorized to investigate the validity of any information entered on this document. Signature of officer or trustee Date Name and title of officer or trustee (please print) Email address of officer or trustee |