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 Internal Revenue Service classification of 501 (c) (3) or 501 (c) (4) 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) or
                 a 501 (c) (4), 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 # _________

        Erin Russell                                                   Sales Tax Account No. __________________________
        CBJ Revenue Officer