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                               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.



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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



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                                      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



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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






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