Exemption Recertification

1. Articles of Incorporation (current) - Please provide a copy of Articles of Incorporation in PDF format.  
2. By-Laws – Please provide copy of By-laws in PDF format. Could also be referred as Constitution.
3. IRS 501(c)(3) – Please provide PDF copy of completed IRS 501(c)(3) form. The following link provides additional information: https://www.irs.gov/pub/irs-pdf/p4220.pdf Publication 4220 (Rev. 3-2018) (irs.gov)
4. Contact information – Please provide list of name(s), email(s), and daytime phone number(s) of representative(s) of organization in PDF format.
5. Board of Directors - Please provide list of members of Board of Directors in PDF format. If this information is in Articles of Incorporation or By-laws, provide 1-page document in PDF format indicating which attached document provides this information.
6. Worship Service Bulletin – Please provide PDF of bulletin or PDF of screenshot of online bulletin.
7. Proof of non-profit status granted by Commonwealth of PA.  
8. Statement detailing activities of the organization – Please provide statement detailing activities of the organization in PDF format. This may be a mission statement. If this information is in Articles of Incorporation or By-laws, provide 1-page document in PDF format indicating which attached document provides this information.
9. Statement acknowledging that none of the income of worship and/or worship related organizations inures to the benefit of any Board member, director, or leader (other than salaried employees as listed above) - signed and acknowledged from Senior member, Secretary of Board, or LLC member. See attached document:  Income Statement
10. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22 

Note:  If the property assessment (see box above) is partially taxable and partially exempt, you will be required to detail the percentage of the total improvement/building area that is utilized for the exempt purpose.  This calculation is accomplished by first computing the total square footage of the building and computing the square footage utilized for the exempt purpose.  Then, divide the exempt purpose square footage by the total square footage to arrive at a percentage of building area attributed to the exempt purpose.  This calculation may be utilized to determine the amount of total assessment is attributed as exempt versus taxable.  The same percentage may be applied to the land area if deemed appropriate. 

Example: Exempt Square Footage = 1,000 sq. ft. 

 Total Square Footage = 5,000 sq. ft. 

 1,000 sq. ft.  ÷ 5,000 sq. ft.  = 0.20 or 20% of the total building area is attributed for the  

                           exempt purpose. 

1. Advertisement or publication – Please provide copy or advertisement or publication of services and/or activities in PDF format. If applicable, please provide pictures of sign(s) in PDF format.
2. Articles of Incorporation  
3. By-Laws  
4. Contact information – name, mailing address, day telephone (cell and/or land line) number of responsible individual(s) 
5. IRS 501(c)(3) letter approving tax exempt status. 
6. IRS 990 (most recently completed year) - Please provide PDF copies of completed IRS 990 form. The following link provides sample form. 2020 Form 990 (irs.gov). https://www.irs.gov/pub/irs-pdf/f990.pdf
7. Board of Directors or other governing body including total salaries and compensation received by individuals. 
8. Describe in memorandum form, in detail, how organization meets the following statutory requirements - Please provide statement detailing activities of the organization in PDF format. This may be a mission statement. If this information is in Articles of Incorporation or By-laws, provide 1-page document in PDF format indicating which attached document provides this information:  
   1. Advance a charitable purpose. 
   2. Private profit motive – operate entirely free from private profit motive. 
   3. Community Service – donate or render gratuitously a substantial portion of its services.  
   4. Charity – benefit a substantial and indefinite class of person who are legitimate subjects of charity. 
   5. Relieve Government from some of its burden. 
9. Pertinent lease information – If you are leasing any portion of the property, please provide copies of lease in PDF format. If you are NOT leasing any portion of the property, please provide a 1-page document (typed or hand-written) stating that no portion of the property is being leased.
10. PA Constitutional Verification that organization is founded, endowed, and maintained by public or private charity. 
11. Statement acknowledging that none of income of organization inures to benefit of any Board member, director, or leader (other than salaried employees as listed above) - signed and acknowledged from Senior most member, Chairman, Secretary to the Board, or LLC member. See attached document: Income Statement
12. Statement detailing activities of organization and why organization should retain tax exempt status - signed and acknowledged from the Senior member or Secretary of the Board. 
13. PA Constitutional Verification that organization is founded, endowed, and maintained by public or private charity. - Please provide statement detailing how organization founded, endowed, and maintained in PDF format. If this information is in Articles of Incorporation or By-laws, provide 1-page document in PDF format indicating which attached document provides this information.
14. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22

Note:  If the property assessment (see box above) is partially taxable and partially exempt, you will be required to detail the percentage of the total improvement/building area that is utilized for the exempt purpose.  This calculation is accomplished by first computing the total square footage of the building and computing the square footage utilized for the exempt purpose.  Then, divide the exempt purpose square footage by the total square footage to arrive at a percentage of building area attributed to the exempt purpose.  This calculation may be utilized to determine the amount of total assessment is attributed as exempt versus taxable.  The same percentage may be applied to the land area if deemed appropriate. 

Example: Exempt Square Footage = 1,000 sq. ft. 

 Total Square Footage = 5,000 sq. ft. 

 1,000 sq. ft.  ÷ 5,000 sq. ft.  = 0.20 or 20% of the total building area is attributed for the  

                           exempt purpose. 

1. Advertisement or Publication demonstrating the purpose or objective of organization.  
2. Articles of Incorporation  
3. Audit Documentation as filed with the PA Department of Community and Economic Development (DCED) for the most recently completed year. – Please provide copies of audit documentation in PDF format for the most recently completed year.  
4. By-Laws  
5. Contact information – name, mailing address, day telephone (cell and/or land line) number of responsible individual(s)   
6. Statement – containing current members of Board or other governing body including salaries and compensation - signed and acknowledged. 
7. Lease Information – If municipality/authority is a lessor, please provide lease. If no lease exists, please provide written explanation of ownership in PDF format. 
8. Statement verifying that none of the income of the organization inures to the benefit of any Board member, director, or leader (other than salaried employees or Board members as listed above) - signed and acknowledged from the Senior member or Secretary of the Board. See attached document:  Income Statement
9. Statement detailing activities of the organization and how Authority meets requirements of Municipality Authorities Act and should retain exempt status - signed and acknowledged by the Senior member or Secretary of Board. 
10. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22

Note:  If the property assessment (see box above) is partially taxable and partially exempt, you will be required to detail the percentage of the total improvement/building area that is utilized for the exempt purpose.  This calculation is accomplished by first computing the total square footage of the building and computing the square footage utilized for the exempt purpose.  Then, divide the exempt purpose square footage by the total square footage to arrive at a percentage of building area attributed to the exempt purpose.  This calculation may be utilized to determine the amount of total assessment is attributed as exempt versus taxable.  The same percentage may be applied to the land area if deemed appropriate. 

Example: Exempt Square Footage = 1,000 sq. ft. 

 Total Square Footage = 5,000 sq. ft. 

 1,000 sq. ft.  ÷ 5,000 sq. ft.  = 0.20 or 20% of the total building area is attributed for the  

                           exempt purpose. 

1. Articles of Incorporation  
2. By-Laws  
3. Contact information – name, mailing address, day telephone (cell and/or land line) number of responsible individual(s) 
4. Parcel Description Document - as many parcels may be owned by one Public Utility, a separate description of each parcel is to be provided detailing specific use and whether the parcel is locally taxable and/or listed on the PURTA tax roll. – Please provide document in PDF format describing the parcel and what it is being utilized for.   
5. Statement detailing activities of the organization and why the organization should retain exempt status and how organization meets requirements as a public utility - signed and acknowledged from the Senior member or Secretary of the Board.
6. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22

1. Contact information – name, mailing address, day telephone (cell and/or land line) number of responsible individual(s) 
2. Parcel Description Document - a separate description of each parcel owned by the school detailing its specific use in a written explanation in PDF format. 
3. Board of Directors or other governing body including total salaries/compensation received by individuals.  
4. Administrative Unit Number (AUN) Form – Please provide copy of AUN form in PDF format. 
5. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22

Note:  If the property assessment (see box above) is partially taxable and partially exempt, you will be required to detail the percentage of the total improvement/building area that is utilized for the exempt purpose.  This calculation is accomplished by first computing the total square footage of the building and computing the square footage utilized for the exempt purpose.  Then, divide the exempt purpose square footage by the total square footage to arrive at a percentage of building area attributed to the exempt purpose.  This calculation may be utilized to determine the amount of total assessment is attributed as exempt versus taxable.  The same percentage may be applied to the land area if deemed appropriate. 

Example: Exempt Square Footage = 1,000 sq. ft. 

 Total Square Footage = 5,000 sq. ft. 

 1,000 sq. ft.  ÷ 5,000 sq. ft.  = 0.20 or 20% of the total building area is attributed for the  

                           exempt purpose. 

1. Articles of Incorporation  
2. Audit Documentation as filed with the PA Department of Community and Economic Development (DCED) for the most recently completed year. 
3. By-Laws  
4. Contact information – name, mailing address, day telephone (cell and/or land line) number of responsible individual(s). 
5. Statement containing current members of Board or other governing body including salaries and compensation signed and acknowledged. 
6. Lease Information – If authority is a lessor, please provide lease. If no lease exists, please provide written explanation of ownership in PDF format. 
7. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). If you are unable to obtain/uncover a deed, please complete and have notarized the attached affidavit.  See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx.  Complete attached Deed Affidavit if you cannot obtain copy of deed:  Deed Affidavit 2-11-22

Example: Exempt Square Footage = 1,000 sq. ft. 

 Total Square Footage = 5,000 sq. ft. 

 1,000 sq. ft.  ÷ 5,000 sq. ft.  = 0.20 or 20% of the total building area is attributed for the  

                           exempt purpose. 

1. Articles of Incorporation (current) - Please provide a copy of Articles of Incorporation in PDF format.  
2. By-Laws – Please provide copy of By-laws in PDF format. Could also be referred to as Constitution.
3. EITHER IRS 990 (most recently completed year) OR IRS 501(c)(3).

• • If IRS 990 form, please provide PDF copy of most recently completed year. The following link provides sample form. 2020 Form 990 (irs.gov). https://www.irs.gov/pub/irs-pdf/f990.pdf

• • If IRS 501(c)(3) – Please provide PDF copy of most recently completed IRS 501(c)(3) form. The following link provides additional information: https://www.irs.gov/pub/irs-pdf/p4220.pdfPublication 4220 (Rev. 3-2018) (irs.gov)

4. Contact information – Please provide list of name(s), email(s), and daytime phone number(s) of representative(s) of organization in PDF format.
5. Board of Directors - Please provide list of members of Board of Directors in PDF format. If this information is in Articles of Incorporation or By-laws, provide 1-page document in PDF format indicating which attached document provides this information.
6. Proof of non-profit status granted by Commonwealth of PA.  
7. Statement detailing activities of the organization in PDF format.
8. Please provide a copy of most recent deed to the extent that you are reasonably able (in PDF format). See following link to Dauphin County Recorder of Deeds website: https://deeds.dauphinc.org/OnCoreweb/Search.aspx. If you are NOT able to obtain/uncover a deed, please complete and have notarized the attached Deed Affidavit:  Deed Affidavit 2-11-22