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 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 |