Finance Department, Sales         Tax   Office 
                                                                                                                                             155 South Seward       St., Juneau, AK 99801 
                                                                                                                                Ph (907) 586     5215‐      ext 4901 Fax (907) 586 0365    ‐
                                                                                                                                                             sales.tax.office@juneau.org

                                        Application for Nonprofit                             Sales     Tax     Exemption            Certificate 

1) ORGANIZATION NAME 
   (Legal name as   provided on Articles of Incorporation,     or if unincorporated,     the governing  document) 

2) ORGANIZATION MAILING              ADDRESS                                                                                                   My organization maintains   a   physical    
   Street Address or   P.O. Box number                                                                                                         presence   in the City/Borough  of   Juneau
                                                                                                                                                         YES                 NO
   City                                                                       State/Province                          Zip Code                Country if   outside U.S. 

3) CONTACT INFORMATION                 OF  REPRESENTATIVE             SUBMITTING           THIS APPLICATION 
   Name                                                                                                                                       Title

   Email Address                                                                                                      Daytime Phone and      Extension 

4) READ AND    INITIAL 
        I hereby apply*     for  a Sales   Tax exemption          Certificate under        Provision    12 of the Sales   Tax Ordinance    CBJ 69.05.040.                  

        I certify the attached       evidence    of our   IRS classification   of 501(c)(3),      501(c)(4),    or 501(c)(19)   is in good     standing      

        I am aware  that    all   nonprofit organizations            that maintain       a physical   presence  within the City and Borough              of Juneau   
        must register       with the Sales    Tax Office       and report their sales. 
        I am aware  this    certificate     exempts       the organization’s   purchases          and those    sales that are not subject     to federal   income tax.            

5)
   Signature                                                                                                                                  Date

   *    Applications MUST be         accompanied          by the following required        attachments: 
               1) A copy    of   the letter from the Internal     Revenue  Service       announcing     your classification  status as a 501(c)(3),     
                    a 501(c)(4),     or     a 501(c)(19), and  
               2) Payment of   the $20.00      application       fee, and 
               3) A completed        CBJ Business Registration        Form This ‐ only applies   to nonprofit   organizations that maintain    a physical presence      within               
                    the City and     Borough  of   Juneau that    have not previously        registered with the  Sales Tax  Office.    

        Applications received without         the required        documents or payment        will not  be processed.  

                                                                               FOR OFFICE               USE  ONLY 

     Certificate Number                                                                                                             Date

                                                                                                        Fee Paid $                            Cash ___          Check   # _________

        Ruth Kostik                                                                                        Sales Tax Account        No.  __________________________  
        CBJ Revenue         Officer