County of Fairfax, Virginia 
               
              To protect and enrich the quality of life for the people, neighborhoods and diverse communities of Fairfax County 
      
                              APPLICATION FOR EXEMPTION FROM         
                  BUSINESS  , PROFESSIONAL AND  CCUPATIONAL O ICENSE L   AXT  
                           AND/OR TANGIBLE  ERSONAL P     ROPERTY P AXT   
          FOR NON PROFIT - HARITABLE  C DUCATIONAL , E OR ,ECREATIONAL R RGANIZATIONSO             
 
Instructions: 
This application is for use by non-profit charitable, educational, or recreational organizations only. The 
information requested is to be filled out in its entirety and returned to the Department of Tax 
Administration at the address given above. Questions that cannot be answered within the space provided 
may be answered by attaching additional sheets to this application. Question 9 identifies specific pieces of 
documentation required as part of the exemption application. Failure to supply this information may result 
in a delay in processing the application. Any supplemental information which best identifies the purposes, 
goals, and activities of the organization should be submitted with the completed exemption application. 
The application must be signed by a member who can attest to the organization’s operations. The 
Department of Tax Administration will mail a written notification of determination after the application 
and all supporting documentation have been examined. This notification will identify whether an 
exemption has been granted, and for which tax it applies. Until a written notification is received from this 
office, the organization is instructed to continue filing all appropriate tax documents and returns in a 
timely fashion. A failure to file returns may result in an assessment of penalties if an exemption is not 
granted. If you have any questions regarding the exemption process, please phone 703-222-8234, TTY 
703-222-7594. 
 
Criteria: 
Organizations submitting this application must operate for non-profit charitable, educational, or 
recreational purposes. To be exempt from local taxation in Fairfax County, an organization must meet the 
requirements for exemption as set by the Code of Virginia and the Code of the County of Fairfax. 
Exemption from the tangible personal property tax can only be granted when the organization’s purpose 
and use of property are within the exemption provisions of the Constitution of Virginia, Article X, Section 
6, or the organization is classified or designated exempt under the statutory provisions of the Code of 
Virginia, Section 58.1-3606 et seq. Exemptions to Fairfax County’s Business, Professional, and 
Occupational License (BPOL) tax are defined under Section 4-7.2-1(B)(2) of the Code of the County of 
Fairfax, and certain exclusions found in Chapter 37, Title 58.1 of the Code of Virginia. Copies of the Code 
of Virginia and the Code of the County of Fairfax are available at all Fairfax County Libraries.  
                
Note: A designation of exemption from federal taxes by the Internal Revenue Service (IRS) does 
not automatically preclude liability from tangible personal property or business licensing taxation at 
the local level. Each application is adjudicated in accord with the governing State and County 
statutes.

                                              DEPARTMENT OF TAX ADMINISTRATION (DTA)
                                                              PERSONAL PROPERTY DIVISION
                                                                    12000 Government Center Parkway, Suite 261
                                                                                       Fairfax, VA 22035
                                                       Phone: 703-222-8234; TTY: 703-222-7594; Fax: 703-324-4171
                                                                             www.fairfaxcounty.gov/dta

                                      APPLICATION FOR EXEMPTION FROM                    
                          BUSINESS  , PROFESSIONAL AND  CCUPATIONAL O                ICENSE L AX T          
                                AND/OR BUSINESS  ERSONAL P          ROPERTY P        AXT    
               FOR NON PROFIT - HARITABLE  C     DUCATIONAL , E     OR , ECREATIONAL R     RGANIZATIONSO        
    
Organization Name:            _________________________________________________________________ 
Mailing Address:              _________________________________________________________________ 
                              _________________________________________________________________
                              _________________________________________________________________
Fairfax Location:             _________________________________________________________________ 
                              _________________________________________________________________ 
                              _________________________________________________________________ 
Contact Person:               _________________________________________________________________ 
Contact Title:                _________________________________________________________________ 
Contact Telephone/e-mail:     _________________________________________________________________ 
 
1. What is the organization’s purpose? 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 
 
2. What is the organization’s federal tax designation? (Circle one) 
   501(c)(3)       501(c)(4)          501(c)(6)         501(c)(7)             Other: 501(c)(   ) (please insert #) 
    
3. How is the organization funded? 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 
 
4. When was the organization first established? ________________________________________________ 
 
5. When did the organization begin operations in Fairfax County? _________________________________ 
 
6. What activities or services are provided by the organization? Does it engage in any activities unrelated to  
   the purpose for which the organization was established? Please describe. 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 
 
7. For what purposes are receipts used? 
   _____________________________________________________________________________________ 
   _____________________________________________________________________________________ 

                              Fairfax County Department of Tax Administration, Personal Property Division  
                                12000 Government Center Parkway, Suite 261   ŠFairfax, VA  22035 
                       Phone: 703-222-8234; TTY: 703-222-7594; Fax: 703-324-4171    Šwww.fairfaxcounty.gov/dta 

                                  APPLICATION FOR EXEMPTION FROM                        
                     BUSINESS  , PROFESSIONAL AND  CCUPATIONAL O                       ICENSE L AXT      
                            AND/OR BUSINESS  ERSONAL P           ROPERTY P             AXT  
           FOR NON PROFIT - HARITABLE  C      DUCATIONAL , E     OR , ECREATIONAL R        RGANIZATIONSO     
 
8.   Does the organization own any real estate, tangible personal property, or vehicles?  If yes, please provide 
     a detailed listing of all property which includes the items’ description, acquisition date, acquisition cost, 
     state vehicle identification number (VIN), vehicle make, and vehicle model.  
 
     Itemized Listing Attached?   ____ Yes  ___ No (Please Explain) 
     _____________________________________________________________________________________ 
     _____________________________________________________________________________________ 
     _____________________________________________________________________________________ 
      
9.   Please enclose a copy of each of the following documentation* with this exemption application. If any of 
     these documents are not available, please identify the document and provide a brief explanation. 
     Š Articles of Incorporation/Organization                    Š Bylaws/Constitution 
     Š IRS Letter of Exempt Designation                          Š Mission Statement 
     Š Recent Federal Tax Filing (Forms 990/990T)                Š Recent Financial Statements 
     Š Pamphlets, Brochures, Weekly Bulletins, Annual Reports, News Letters, Course Catalogs, Membership 
      Directory, Advertising, Tuition/Fee Scales, Certifications or Accreditations, Visitor or New Member 
      Information Packets, or Promotional Literature (Anything which describes the charitable, benevolent, 
      educational or recreational purpose for which the organization was established.) 
      ___________________________________________________________________________________ 
      ___________________________________________________________________________________ 
      ___________________________________________________________________________________ 
      
10.  The space below is provided for any additional comments or remarks the organization desires to make. 
     Please reference the question number should the comment pertain to a particular item requested above. 
     _____________________________________________________________________________________ 
     _____________________________________________________________________________________ 
     _____________________________________________________________________________________ 
 
 11. Please sign this application certifying that to the best of your knowledge and belief the information 
     provided herein is complete and accurate. 
 
     Signature             _________________________________________________________________
     Printed Name          _________________________________________________________________ 
     Title                 _________________________________________________________________ 
     Date                  _________________________________________________________________
      
     * Unincorporated churches which do not have Articles of Incorporation, an IRS determination letter, or Federal Tax Returns, 
     please supply as much documentation as is available to confirm the establishment of a church which holds regularly scheduled 
     and on-going worship services and provides charitable services for the community. 

                           Fairfax County Department of Tax Administration, Personal Property Division  
                            12000 Government Center Parkway, Suite 261   ŠFairfax, VA  22035 
                    Phone: 703-222-8234; TTY: 703-222-7594; Fax: 703-324-4171    Šwww.fairfaxcounty.gov/dta