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Get Pa Rev-956 2020-2025

REV-956 AS 04-15 Bureau of Business Trust Fund Taxes PO BOX 280909 Harrisburg PA 17128-0909 INSTITUTION OF PURELY PUBLIC CHARITY RENEWAL AFFIDAVIT Organization s name as shown on the Application for Sales Tax Exemption REV-72 Current Exemption Number 75An institution of purely public charity applying for renewal of sales tax-exempt status that completes this affidavit will not be required to submit articles of incorporation by-laws or other governing documents as otherwise directed on the Application for Sales Tax Exemption. If the organization is incorporated the affidavit must be signed by a corporate officer. If not incorporated the affidavit must be signed by a responsible party. INCORPORATED INSTITUTION Date of Incorporation Have the articles of incorporation been amended since the date incorporated YES NO If yes date of last amendment s Date of Formation Have the by-laws been amended since the formation date NOTE If the institution has adopted any governance changes after the original filing of the Application for Sales Tax Exemption REV-72 then a copy of any amendments must be provided along with a detailed explanation of how such changes affect the institution* Under penalties of perjury I declare I have examined the above statements and any accompanying documents and to the best of my knowledge and belief all facts relating to this matter contained therein are true correct and complete. Name Signature Title/Corporate Officer Position Daytime Phone Number Street Address City Date State ZIP Code Notarization Subscribed and sworn before me this day of My commission expires Signature of Notary Public. If not incorporated the affidavit must be signed by a responsible party. INCORPORATED INSTITUTION Date of Incorporation Have the articles of incorporation been amended since the date incorporated YES NO If yes date of last amendment s Date of Formation Have the by-laws been amended since the formation date NOTE If the institution has adopted any governance changes after the original filing of the Application for Sales Tax Exemption REV-72 then a copy of any amendments must be provided along with a detailed explanation of how such changes affect the institution* Under penalties of perjury I declare I have examined the above statements and any accompanying documents and to the best of my knowledge and belief all facts relating to this matter contained therein are true correct and complete. Name Signature Title/Corporate Officer Position Daytime Phone Number Street Address City Date State ZIP Code Notarization Subscribed and sworn before me this day of My commission expires Signature of Notary Public.

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