FINANCE DEPARTMENT                                                             SALES TAX DIVISION 
 P.O. BOX 1427                                                                  (719) 553-2659 
 PUEBLO, CO  81002                                                              FAX (719) 553-2657 
                      
                      APPLICATION FOR EXEMPT LICENSE 
 
 INSTRUCTIONS: 
 
 This form must be filled out completely and returned to the Sales and Use Tax Division of the 
 Department of Finance before any request for exemption from Pueblo Sales and Use Tax can be 
 considered. If you are unable to fit your responses in the spaces provided, please use the back side of 
 the sheet containing the question or attach additional paper. Please note that depending on the 
 Responses provided, further information may be requested. 
 
 In addition, the following information must be submitted with the application: 
 
         a.    Complete Articles of Incorporation (including amendments and name changes). 
         b.    Current and one prior year’s financial statements that must reflect detailed sources of 
               income and expenditures. 
         c.    Copy of IRS 501(c)(3) Determination Letter. 
         d.    A list of the types of items the organization would be purchasing using this exemption. 
 
 ORGANIZATION: 
 
 Name:                                                        Date:                                 
 
 Address:                                                    
 
 Email:                                                      
 
 Phone:                                                      
 
 Person to contact:                                         
 
 Contact person’s signature:                                 
 
 Title:                                                     
 
 Organization Web Site Address:                             
 
 Nature of Business:                     
 
 Pueblo Sales/Use Tax #                                       

 REQUIRED RESPONSES: 
 
 1. Please identify those activities in which the organization exclusively ministers to the spiritual, 
    physical or mental needs of persons (herein the “Services”). 
 
 2. Are these services provided free? If not, please answer the following: 
 
    (a) What are the pricing and fee structures for the services provided? Please attach recent 
        advertisements or current brochures, if any, with respect to such services. 
    (b) What provisions are made to assist those who are financially unable to pay the fees or 
        payments, and what percentages of Services are provided to those who are financially 
        unable to pay the fees? 
    (c) What conditions or requirements, if any, must an individual satisfy to receive the 
        services? 
    (d) Identify the salaries of the five highest paid employees or directors of the organization. 
        Please list them by position, salary amounts, and job duties. 
 
 3. What are the organization’s primary sources of funds and approximate percentages from each? 
    (e.g. dues, contributions, grants, fees or payments from Services, etc.) 
 
 4. Estimated annual savings from City of Pueblo sales and use taxes. (Total value of taxable 
    purchases $                     multiplied by 3.70% equals $                    estimated tax 
    savings.) 
 
 5. How do the services lessen the burden of government? (If you are a religious organization, you 
    need not answer this question.) 
 
 6. Are the services provided within the City of Pueblo or for the benefit of the residents of the City 
    of Pueblo? If yes, please identify where within the City of Pueblo the services are provided and/ 
    or how the residents of the City of Pueblo are benefitted. 
 
 7. Are there any limitations with respect to who is eligible to receive the services? If yes, for each 
    service provided, please identify all limitations. 
 

                                                                                                                One City Hall Place 
                                                                                                                                                             Pueblo, CO 81003    
                                                                                                       
Valerie A. Palumbo                                        Sales Tax Division                                   (719) 553-2659 – Phone  
 Tax Audit Manager                                                            www.pueblo.us                                                   (719) 553-2657- Fax                       
                                                                                                                 salestax@pueblo.us  
                                                                                                                                                     
                                                                             Attachment A 
                                        QUALIFYING EXEMPT SERVICES: 
                                                                                  
Below please see the definition of “Charitable Organization” stated in the Pueblo Municipal Code 
14-4-21 Definitions (5): 
   
  (5)  Charitable organization means any entity which:  
       a. Has been certified as a not-for-profit organization under Section 501(c)(3) of the Internal Revenue 
       Code; and  
       b. Is a religious or charitable organization.  
  As used in this definition, a charitable organization is an organization which exclusively, and in a manner 
  consistent with existing laws and for the benefit of an indefinite number of persons, freely and voluntarily 
  ministers to the physical, mental or spiritual needs of persons, and which thereby lessens the burdens of 
  government.  

Based on the above definition please state how the organization meets this requirement and specifically how the 
activities lessen the burden of the local government: 

                                                                                                                                                      RK/VP 9-13-17