Form ST-119.2, Application for an Exempt Organization Certificate Completed Form Examples and Samples

Explore comprehensive examples and samples of a filled-out Form ST-119.2, Application for an Exempt Organization Certificate. Our detailed guide provides clear instructions to help New York nonprofits correctly complete the form and secure their sales tax exemption status.
Form ST-119.2, Application for an Exempt Organization Certificate has a moderate Form Complexity Index of 48/100 — Instafill’s AI completes it in under a minute.
Fill out form with AI
Download PDF Example
Field Instructions
Completed Form ST-119.2 Application for an Exempt Organization Certificate for a 501(c)(3) educational nonprofit.

Form ST-119.2 Example – Educational Nonprofit Organization

How this form was filled:

This sample Form ST-119.2 is filled out for a fictional educational nonprofit, 'Future Leaders Youth Program.' The example correctly provides the organization's legal name, Federal EIN, a detailed description of its tax-exempt purpose, and includes information from its IRS 501(c)(3) determination letter, which are all critical for a successful application.

Information used to fill out the document:

  • Organization Name: Future Leaders Youth Program
  • Federal Employer Identification Number (EIN): 98-7654321
  • Principal Address: 456 Education Avenue, Albany, NY 12207
  • Date of Formation: January 15, 2022
  • State of Incorporation: New York
  • IRS Exemption Section: 501(c)(3)
  • Date of IRS Determination Letter: March 10, 2022
  • Primary Purpose: To provide after-school tutoring, mentorship, and leadership development programs for underprivileged youth.
  • Contact Person: Jane Smith, Executive Director
  • Contact Phone: (518) 555-0101
  • Signature: Jane Smith
  • Date of Application: April 22, 2026

What this filled form sample shows:

  • Clearly states the organization's legal name and Federal EIN.
  • Provides a detailed description of the charitable and educational purpose of the organization.
  • Includes essential information from its IRS 501(c)(3) determination letter, including the effective date.
  • Correctly filled with an authorized officer's signature and a current application date.

Form specifications and details:

Form Name: Form ST-119.2, Application for an Exempt Organization Certificate
Jurisdiction: New York State Department of Taxation and Finance
Use Case: Application for a sales tax exemption certificate by a 501(c)(3) educational nonprofit organization.
Created: February 25, 2026 06:05 PM
Completed Form ST-119.2 Application for an Exempt Organization Certificate for a 501(c)(3) educational nonprofit.