Affidavit of Exemption from City of Colorado Springs Sales Tax

Return to Issuing Hotel/Motel

Revised–July1,2009

Affidavit of Exemption from City of Colorado Springs Sales Tax

TheCityofColoradoSpringsSalesTaxDivisionrequiresthat thisaffidavit must becompletedby any organizationrequesting exemptionfromCitySalesorLodgersTaxat local hotelsormotels. If an organization does notcomplete this form,exemptionwill not be granted. Ifyouhaveany questionabout this affidavit, pleasecontact theSalesTaxDivisionat (719)385-5903.

Name of Organization:

Address:

Yes No

[ ] [ ] Statetaxexempt?Stateof

StateExemption Number

Category: Charitable

Religious

Government

Not-for-Profit School

Name ofHotel: Date(s)of meeting: Pleaseanswerthefollowingquestionsandreturnthisaffidavittothehotelormotel. Allquestionsmustbeanswered“Yes”

forthepurchasetoqualifyasexempt.

Yes No

[ ] [ ] Is theorganizationa governmentalentity,a not-for-profitschool,a qualifiedreligiousorganization,ora qualified charitableorganization?(Inorderfora religiousorcharitableorganizationto bequalified,theorganizationmustbe classifiedas501(c)(3)undertheInternalRevenueCode,andtheorganizationmustbedescribedin Section170(c)of

theInternalRevenueCodeof1986,i.e.,donationsto thisorganizationaredeductibleontheFederalIncomeTaxReturnof

thedonor.If youdonotknowabsolutelythattheorganizationis a 501(c)(3)and170(c),orcannotproveit,the organizationdoesnotqualify,andthisquestionmustbeanswered“No”.)

Yes No

[ ] [ ] Isthispurchasebilleddirectlytotheorganizationandpaidfordirectlybytheorganizationfromfundsofthe organization? Purchasesbygovernmentalemployeesusingcash,personalchecksorcreditcardsissuedtoindividualsare notdirectpurchasesby thegovernmentandarenottaxexempt.Proofofpaymentwithorganizationfundsis required.

Yes No

[ ] [ ] If paymentis madebycreditcard,is thecreditcardissuedto thetax-exemptorganizationmakingthepurchaseandnot

N/Atheindividualpresentingthecard?(Inorderforthisquestionto beanswered“Yes”,themonthlystatementofthecredit

[ ]cardcompanymustbemaileddirectlyto andpaiddirectlybythetax-exemptorganizationandnottheindividual,andthe individualpresentingthecard musthavenoresponsibilityorliabilityforpaymentofthecreditcard bill. Proofonpayment withorganizationfundsis required.

Theundersigned declaresandaffirmsthattheabovequestionsareansweredtruthfully,thathe/shehassufficient knowledgeaboutthepurchasetoanswerthequestionscompletely, andthatthepurchaseismadeforusebythe organizationinitsexemptcapacity.

Name(PleasePrint)Title

SignatureDate

Reviewedby Hotel/Motel:

Date

Note:Thehotelshouldkeepthisaffidavitonfileasproofofexemption,alongwithproofofpaymentwith organizationfundsdocumentation.