Financial Services 
                                                                                                                        215 North Mason Street, 2
                                                                                                                        Sales Tax Division          nd Floor 
                                                                                                                        P.O.  Box 580 
                                                                                                                        Fort  Collins, CO 80522 
                                                                                                                        970.221.6780 
                                                                                                                        970.221.6782 - fax 
                                                                                                                        fcgov.com/salestax 
                                                                                                                          
                                                  APPLICATION FOR EXEMPTION FROM THE CITY OF FORT COLLINS SALES TAX 
                                                   (As required by Section 25-94 of the City of Fort Collins City Code) 
                                                                       
Please refer to the instructions on the back of this form. 
 
PLEASE TYPE OR PRINT: 
 
N  armzt            eg  oaonfai n:Oi
 
Ad:dress                
   Street      City     Zip Code 
Telephone:                                            Fax Number:         Location of Records:                                                                
 
Email Address:_____________________________________________ 
 
Organization located within city limits of Fort Collins? (Circle one)  Yes No 
 
Officers:  (If more than three, please provide additional list) 
 
1.a  mN          P    e:                                                                        hone: 
 
 A :                         ddress               
 
2.a  mN          P    e:                                                                        hone: 
 
 A :                         ddress               
 
3.a  mN          P    e:                                                                        hone: 
 
 A :                         ddress               
 
DateOrganized:     Date  Activities:                                   Began      
 
Brtieeemrfn ggstrat daeae  t            ic ni:vis  ti
 
I declare under penalty of perjury that the statements made in this application are true and complete to the best of 
my knowledge. 
 
Signature/Title                                                        Date 
 
                                   Note:  Section 25-94(c) provides that your organization provide complete reports of all purchases if requested. 

INSTRUCTIONS: 
1) List all officers of your organization. 
2) Attach copies of the following documents: 
             Articles of Incorporation. 
             Federal tax exemption letter and forms required by Internal Revenue Service Code Section 501(c)(3). (Form 1023) 
             Bylaws. 
             Colorado Certificate of Incorporation. 
             Copy of Colorado exemption certificate. 
3) Submit financial statements showing source of funds and expenditures. 
4) Return to the City of Fort Collins Sales Tax Office, P.O. Box 580, Fort Collins, CO  80522. 
 
                                                      For Office Use Only 
                                                        
                                                      Signature        
Date Approved                  Date Disapproved            Financial Officer