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       GOVERNMENT        OF      THE 
       DISTRICT  OF  COLUMBIA                              APPLICATION FOR EXEMPTION, FR-164 
       OFFICE OF TAX AND REVENUE                        (Check Appropriate Boxes) 
       P.O. BOX 556
                                                           INCOME AND FRANCHISE TAX 
       WASHINGTON,  DC  20044-0556                         SALES AND USE TAX (SEMIPUBLIC INSTITUTION ONLY)    
       FAX # (202) 442-6883                                PERSONAL PROPERTY TAX (SEMIPUBLIC INSTITUTION ONLY) 
 1.
    Full name of organization
                                                                                                    
                                                                                             FEIN #
 2.
    Complete address (number, city/town and Postal Zip Code of the organization: P.O. Box is not acceptable.) 
    including Web site 

 3.
    Federal Exemption Status: 
     IRS Determination Letter effective date                  Internal Revenue Code Section 
   
      Application filed (if not recognized)  Date              Internal Revenue Code Section
 4.
    Form of Organization:
      Corporation       Date of incorporation                         State 
       Other-Describe
 5.
    Purpose of Organization:
       Religious           Library           Other:  Explain: 
       Charitable          Educational
       Scientific          Hospital 
 6. Principal Sources of Income:
        Donations          Assessments      Interest                         Other:  Explain 
        Grants              Initiation Fees Dividends
       Dues                Rents            Business Operations 
 7.
    End of Annual  Accounting Period:

 8.
    Date activities began in the District:

 9a. Physical Location(s) of Personal Property in the District:  
   
 9b.   Type of Personal Property Owned by Organization:    
       (Also list total cost of property owned and located in the District) 

Person Authorized to Discuss Application for Exemption: 
 Name:                                                              Title:                                       
  
Telephone:                      FAX:                        E-mail: 
  
Address:                                                     
 
                                            SIGNATURE AND VERIFICATION
 Under the penalties provided by law, I declare that I have examined this application, including accompanying 
 statements, and to the best of my knowledge and belief it is true, correct and complete. 

 Signature of Officer                                Title                          Date

  FR-164 (Rev. 12/2012)                      PLEASE COMPLETE REVERSE SIDE

10a. Does the organization control or is it controlled by any other organization?          Yes
If "Yes", attach explanation.                                                              No

10b. Is the organization the outgrowth of (or successor to) another organization,          Yes
or  does  it  have  a  special  relationship  with  another  organization  by  reason  of 
interlocking directorates or other factors?                                                No

If "Yes", attach explanation. 

10c. Other than a statutory office,do you maintain                                         Yes
regular places of business outside the District? 
If "Yes", attach a statement indicating the locations.                                     No

10d. Does the organization report any unrelated business income on Form 990T to the IRS?   Yes
If "Yes", attach an explanation of the nature of the organization's unrelated              No
business activities or provide a copy of the latest filed Form 990T. 

10e. Does the organization file a Form 1120POL U.S.Income Tax Return                       Yes
for Certain Political Organizations with the IRS? 
                                                                                           No
If "Yes", attach an explanation of the nature of the organization's political 
activities and provide a copy of the latest filed Form 1120POL. 

10f. Did the organization establish a political action committee                           Yes
described in section 527(f)(3) of the Internal Revenue Code? 
If "Yes", attach an explanation of the nature of the organization's political              No
activities and provide a copy of the latest filed Form 1120POL. 

10g. Does the organization sell any tangible personal property or provide                  Yes
personal services to persons or organizations located within the District? 
                                                                                           No
If "Yes", attach an explanation of the nature of the organization's activities. 

10h.  Did  the  organization  purchase  any  tangible  personal                            Yes
property outside the District for use in the District?                                     No
If "Yes", did the organization file an appropriate sales & use tax return
with the District? If no please attach an explanation. 

                                         General Information 
  
This application is for use by organizations who wish to apply for an exemption from the District of Columbia 
Income and Franchise Tax, Sales and Use Tax and Personal Property Tax. All questions on the application must be 
answered completely. Mail the completed application, with the various documents requested in the specific 
instructions, to the: 
  
Office of Tax and Revenue, P.O. Box 556, Washington,DC 20044-0556, Attn: Exempt Organizations. 
If you have questions, please call (202) 442-6586 between the hours of 7:00 a.m. and 4:30 p.m. Tuesday through 
Thursday. 
  
Applicants for Income and Franchise Tax Exemption under Sec. 47-1802.1 of the DC Code: 
  
Most  organizations  recognized  by  the  Internal  Revenue  Service  will  qualify  for  exemption  under  the  District  of 
Columbia Income and Franchise Tax Act. The effective date for all income and franchise tax exemptions will be the 
effective date of the IRS Determination. 
  
Applicants for Sales and Use Tax Exemption under Sec. 47-2005 of the DC Code: 
  
Under  the  District  of  Columbia  Sales  and  Use  Tax  Act  sales  made  to  any  organization  which  qualifies  as  a 
“semipublic institution" are exempt from the tax. A "semipublic" institution is defined under Sec. 47-2001(r) of 
the Act as "any corporation, and any community chest, fund, or foundation, organized exclusively for religious, 
scientific, charitable, or educational purposes, including hospitals, no part of the net earnings of which inures 
to the benefit of any private shareholder or individual." This exemption is limited to those organizations, which 
have been recognized as tax exempt under Section 501(c) (3) of the Internal Revenue Code of 1986 (or comparable 
sections under prior codes). 
  
SEMIPUBLIC INSTITUTIONS ARE RECOGNIZED AS DC SALES TAX EXEMPT IF PHYSICALLY LOCATED IN THE DISTRICT. 
  
The  exemption  applies  only  to  those  transactions,  which  occur  on  or  after  the  date  of  the  issuance  of  a 
Certificate of Exemption by the Office of Tax and Revenue. 
  
Personal Property Tax Exemption under Sec. 47-1508 of the DC Code: 
  
Organizations requesting an exemption from DC Personal Property Tax must own the personal property for which the 
request is being made, and qualify under Title 47, Section 1508 of the DC Code. Organizations that may qualify for 
exemption are any corporation, and community chest, fund or foundation, organized exclusively for religious, 
scientific charitable or educational purposes, including hospitals, no part of the net earnings of which inure to 
the benefit of any private shareholder or individual.  The effective date for personal property tax exemptions 
will be the July 1 following the date of the initial application request. 
  
                                         Specific Instructions 
  
FILE THE FOLLOWING DOCUMENTS WITH THIS APPLICATION: 
(If not currently available, state when they will be furnished). 
  
  A.  A copy of the latest determination or ruling letter you have received from the Internal Revenue   
      Service, which approves your organization's exemption from Federal income tax. 
  
  B.  If incorporated in DC, a copy of your Certificate of Incorporation issued by the DC Department of    
      Consumer and Regulatory Affairs, Corporations Division, or if not incorporated, a copy of your 
    constitution, articles of association, declaration of trust, or other documents whereby you were created 
    setting forth your aims and purposes, a copy of all amendments thereto, and any changes presently proposed. 
  
  C.  If not incorporated in DC a photocopy of a Certificate of Authority or Certificate of Registration issued 
    by the DC Department of Consumer and Regulatory Affairs, Corporations Division, must be submitted to the 
    Office of Tax and Revenue with the Application for Exemption. 
  
  D.  If your organization has ever been recognized as tax exempt by the District, based on a previous 
    application, please provide a copy of your DC letter of exemption or certificate of exemption. 
    
  E.  A copy of a lease, District of Columbia Occupancy Permit issued to organization or other documentation 
    should accompany a request by a semi-public institution (501(c)(3) organization)for sales tax exemption to 
    satisfy the physically located requirement.                      
  
  F.  An organization should file Form FR-500 Combined Business Tax Registration Application with Form FR-164 
    Application for Exemption if not previously registered with the Office of Tax and Revenue.