APPLICATION FOR EXEMPTION FROM BUSINESS, PROFESSIONAL AND 
       OCCUPATIONAL LICENSE TAX AND/OR TANGIBLE PERSONAL PROPERTY 
                            TAX FOR NON-PROFIT ORGANIZATIONS 
    
                                                      County of Fairfax 
                                                      Department of Tax                   Administration 
                                                                                          
                                                      Personal Property and Business License Division 
                                                      12000 Government Center             Parkway Suite 261  
                                                      Fairfax, Virginia 22035             
                                                      (703) 222-8234 TTY: (703) 222-7594  
                                                      E-Mail Address:  dtappd@fairfaxcounty.gov 
                                                                                          
  INSTRUCTIONS TO APPLICANT 
  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  Fairfax  County  Ordinance.  Exemption  from  the 
  tangible personal property tax can only be granted when the organization’s purpose and use of property 
  (a) meet the exemption provisions granted by the Constitution of Virginia, Article X, Section 6, or (b) 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) (1) (A) of the Fairfax County Ordinance, and certain exclusions found 
  in Chapter 37, 58.1-3703 (C) (18) (a) of the Code of Virginia. 

  The  burden  of  showing  that  an  exemption  applies  is  on  the  organization  who  seeks  an  exemption. 
  Exemptions to the property tax are strictly construed.  

  If you wish to apply for an exemption, please complete all applicable sections of this form and return it 
  to the Department of Tax Administration, Personal Property and Business License Division.   

  Note:    Unless  and  until  an  organization  has  been  notified  that  it  is  exempt  from  property  taxes,  the 
  organization is instructed to continue filing all appropriate tax documents in a timely fashion. 
                                                                                                              
I.      Organization Information 
   
  1.    Organization Name:                            _________________________________________________________ 
                                                                                                              
  2.    Organization’s Federal Identification Number:                                    __________________________________ 
                                                                                                              
  3.    Mailing Address:    ___________________________________________________________ 
                                                                                                              
                            ___________________________________________________________ 
  4.    Fairfax  
        Location:          _________________________________________________________________ 
                                                                                                              
  5.    Contact 
        Person/Title:       _______________________________________________________________ 
      
  6.    Telephone:         ________________________________________________________________ 
                                                                                                              
  7.    E-mail:            ___________________________________________________________________ 

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 Designation Information 
    
   1) What is the organization’s federal tax designation?  (Check one) 

       501 (c) (3)             501 (c) (4)*            501 (c) (6)*            501 (c) (7)*             Other * 

                  Please attach a copy of the IRS Designation Notice. 
         *Please provide IRS Forms 990/990T for recent financial statements 
    
   2) In the box below, please select the exemption designation being requested. 

 Church/Religious Body                                Club affiliated with Boys Club of America and 
                                                         Girls Clubs of America 
                                                        
 Non-Profit Cemetery                                   
                                                       Boy Scouts and Girl Scouts of America 
 Library/Non-profit Institution of Learning            
                                                       Home Demonstration Club/4H Club/Future 
                                                         Farmers of America, Inc. 
 Museum                                                  
                                                        
 Young Men's Christian Association or similar         American National Red Cross 
   religious organization 
                                                        
                                                       College Alumni Association or foundation  
 Park/Playground                                       
                                                       Farm Club Association  
 Benevolent or charitable Lodge organization           
                                                       The State Future Farmers of America/Future 
                                                         Homemakers of America/Future Business 
 Volunteer Fire department or rescue squad              Leaders of America 
                                                        
 Society for the Prevention of Cruelty of             Auxiliaries of Veterans of World War I 
 Animals 
                                                                                                                 
 If an exemption category was selected above, please sign the application acknowledging the accuracy of the 
                                           information provided. 

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   II.    Affirmation  

       3) Please sign this application certifying that to the best of your knowledge and belief the information 
          provided herein is complete and accurate. 

       Name (print): _______________________________________________________________________ 
                                                                                                                    
       Signature: __________________________________________________________________________ 
                                                                                                                    
       Title: ______________________________________________________________________________ 
                                                                                                                    
       Telephone Number:    _________________________________________________________________ 

       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.  The  

       Internal Revenue Service (IRS) non-profit 501 (C) determination does provide an exemption from 

       business License taxation (except on unrelated income), but it does not automatically provide an 
       exemption from tangible personal property taxes.   

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