Form ST-119.2, Application for an Exempt Organization Certificate Instructions

Enter the three-digit area code for the contact person's fax number.

Enter the contact person's fax number excluding the area code, including any local prefixes or hyphens as needed.

Enter the contact person's telephone area code (the initial three-digit portion of the phone number).

Enter the remaining digits of the contact person's telephone number excluding the area code.

Check this box if your organization is a cooperative or foreign corporation doing business in New York State pursuant to the Rural Electric Cooperative Law and you are claiming exempt status under Tax Law § 1116(a)(8).

Check this box if your organization is a credit union as defined by New York State Banking Law §2(9) and is the purchaser, user, or consumer of services or property, or is a vendor of services or property of a kind not ordinarily sold by private persons.

Enter the date when the organization was formally organized (the founding/formation date of the entity).

Enter the date when the organization was incorporated (if applicable).

Enter the organization's federal employer identification number assigned by the IRS.

Check this box if any distribution of the organization's property has ever been made to shareholders, members, or other individuals.

Check this box if no distribution of the organization's property has ever been made to shareholders, members, or other individuals.

Enter the email address for the officer, trustee, governing chief, or member of the ruling body who is signing or certifying this application.

Enter the contact person's email address where the Department can send correspondence about this application.

Check this box if your organization is a not-for-profit health maintenance organization subject to Public Health Law Article 44 and you will attach a copy of the certificate of authority issued by the New York State Department of Health.

Check this box if you are an Indian nation or tribe residing in New York State (as listed) filing under §1116(a)(6) and using this optional form; the form must be signed by the governing chief or a member of the ruling body of the nation or tribe.

Enter the organization's mailing street address or P.O. box, including street number, street name and any apartment or suite number if applicable.

Enter the city or town for the organization's mailing address.

Enter the mailing state using the two-letter postal abbreviation (for example, NY).

Enter the mailing ZIP code (5-digit ZIP or ZIP+4 format, e.g., 12345 or 12345-6789).

Enter the full printed name followed by the official title of the officer, trustee, governing chief, or member of the ruling body (for example: Jane Doe, President).

Enter the full name and job title of the person your organization designates as the contact for this application.

Enter the organization's full legal name (the name used for official and tax purposes).

Enter the organization's 3-digit telephone area code (e.g., 212).

Enter the organization's 7-digit local telephone number (the remaining digits after the area code), optionally including a hyphen (e.g., 555-1234 or 5551234).

Enter the organization's physical street address including the building number and street name.

Enter the city in which the organization's physical address is located.

Enter the U.S. state of the organization's physical address (use the standard two-letter state abbreviation if available).

Enter the postal ZIP code for the organization's physical address (5-digit or ZIP+4 format if applicable).

Check this box if your organization is a post or organization (including an auxiliary unit, society, trust, or foundation) organized in New York State of past or present members of the United States armed forces and you are claiming exemption under §1116(a)(5).

Enter the percentage of the post’s or organization’s members who are past or present members of the United States armed forces. Fill only if '1b § 1116(a)(5) — Post/organization organized in New York State' is 'Yes'.

Enter the percentage of the post’s or organization’s members who are cadets or are spouses, widows, widowers, ancestors, or lineal descendants of past or present members of the United States armed forces or of cadets. Fill only if '1b § 1116(a)(5) — Post/organization organized in New York State' is 'Yes'.

Enter the percentage of the post’s or organization’s members who do not fall into either of the two categories listed above. Fill only if '1b § 1116(a)(5) — Post/organization organized in New York State' is 'Yes'.

Check this box if you are claiming exempt status under Tax Law §1116(a)(4) and will indicate the specific purpose(s) below.

Check this box if the organization is religious and you are claiming exempt status under §1116(a)(4) for a religious purpose. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization is charitable and you are claiming exempt status under §1116(a)(4) for a charitable purpose. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization is educational and you are claiming exempt status under §1116(a)(4) for an educational purpose. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization’s exempt purpose under §1116(a)(4) is testing for public safety. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization is scientific and you are claiming exempt status under §1116(a)(4) for a scientific purpose. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization is literary and you are claiming exempt status under §1116(a)(4) for a literary purpose. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization’s exempt purpose under §1116(a)(4) is prevention of cruelty to children or animals. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if the organization’s exempt purpose under §1116(a)(4) is fostering national or international amateur sports competition. Fill only if '1a - Claim exemption under §1116(a)(4)' is 'Yes'.

Check this box if your organization is a corporation (attach a copy of articles of incorporation, including filing receipt, and bylaws and any amendments).

Check this box if your organization is a trust or foundation (attach a copy of the Declaration of Trust, bylaws, and any amendments).

Check this box if your organization is a limited liability company (LLC) (attach a copy of articles of organization, the operating agreement, and any amendments).

Check this box if your organization is a credit union (attach a copy of its federal or New York State charter).

Check this box if your organization is an other type not listed above (attach a copy of its constitution and bylaws and any amendments).

Check this box if no part of the organization's net earnings goes to the benefit of any private shareholder or individual.

Check this box if any part of the organization's net earnings goes to the benefit of any private shareholder or individual.

Check this box if the organization has never attempted to influence legislation.

Check this box if the organization has ever attempted to influence legislation.

Check this box if the organization has ever participated in or intervened, directly or indirectly, in any political campaign or has endorsed or opposed any candidate for public office.

Check this box if the organization has never participated in or intervened, directly or indirectly, in any political campaign and has not endorsed or opposed any candidate for public office.

Check this box if the organization fosters national or international amateur sports competition and provides any facilities or equipment, either directly or indirectly, to anyone.

Check this box if the organization fosters national or international amateur sports competition but does not provide any facilities or equipment, either directly or indirectly, to anyone.

Check this box if the organization has received an exemption from federal income tax under IRC §501(c)(3) and will attach a copy of the federal determination letter confirming that exemption.

Check this box if the organization has not received an exemption from federal income tax under IRC §501(c)(3).

Check this box if you are a branch or chapter and your parent organization has received an exemption under IRC §501(c)(3) that applies to subordinate branches or chapters (attach a copy of the federal determination letter).

Check this box if you are a branch or chapter and your parent organization has not received an exemption under IRC §501(c)(3) that applies to subordinate branches or chapters.

Check this box if your organization is currently registered for sales tax purposes with the New York State Tax Department.

Check this box if your organization is not currently registered for sales tax purposes with the New York State Tax Department.

Enter your organization's sales tax identification number issued by the New York State Tax Department if you are currently registered for sales tax purposes. Fill only if 'Yes (Are you currently registered for sales tax purposes?)' is 'Yes'.

Enter the date when the officer, trustee, governing chief, or member of the ruling body signed the certification.