
*AP20420W121812*
*AP20420W121812*
* A P 2 0 4 2 0 W 1 2 1 8 1 2 *
1.
2. ORGANIZATION NAME
(Legal name as provided on Articles of Incorporation, or if unincorporated, the governing document.)
3. ORGANIZATION MAILING ADDRESS
Street number, P.O. Box or rural route and box number
City State/Province ZIP Code County (or country, if outside the U.S.)
4. Texas taxpayer number (if applicable) ............................................................................................................................
5. Federal Employer Identication Number (EIN) (Required if applying for exemption on the basis of a federal exemption) ......................
6. a) Enter ling information issued by the Texas Secretary of State:
File Number ............................................................. File Date ................................................
Month Day Year
OR
b) Check this box if this organization is not registered with the Texas Secretary of State.
7. Contact information of the person submitting this application
Name Email Address
Firm or Company Name Daytime Phone (Area code and number) Extension
Address City State ZIP Code
Federal Exemption under qualifying Internal Revenue Code (IRC)
Credit Unions - Federal
Section 501(c). Attach IRS Determination Letter.
Credit Unions - State
Cemetery Corporations
Development Corporations
Certain Insurance Corporations for Farm Mutuals, Local Mutual Aid
Electric Cooperatives
Associations and Burial Associations
Emergency Medical Service Corporations
Certain Insurance Corporations Licensed as Title Insurance
Farmers' Cooperative Societies or cooperatives whose single
Companies and Title Insurance Agents
member is a farmers' cooperative described in Section 521(b)(1),
Certain Corporations Subject to the Insurance Code
IRC, that has at least 500 farmer-fruit grower members.
Chambers of Commerce
Health Facility Development Corporations
Convention and Tourist Promotional Agencies
Hospital Laundry Cooperative Associations
Cooperative Associations
Housing Finance Corporations
Cooperative Credit Associations
Local Organizing Committees
Corporations Exempted by Another Law
Lodges
Corporations with Business Interest In Solar Energy Devices
Marketing Associations
Corporations Organized for Agricultural Purposes
Nonprot Water Supply Corporations
Corporations Organized for Conservation Purposes
Open-End Investment Companies
Corporations Involved with City Natural Gas Facility
Corporations Organized to Promote County, City or Another Area
Corporations Organized to Provide Cooperative Housing
(Public Interest Organizations)
Corporations Organized to Provide Convalescent Homes for
Railway Terminal Corporations
Elderly
Recycling Operations
Corporations Organized for Student Loan Funds or Student
Telephone Cooperatives
Scholarship Purposes
Volunteer Fire Departments
Youth Athletic Organizations
We will notify you by email when the exemption has been added to let you know where the exemption can be veried online. If an email address is not
provided, indicate where our response should be mailed: organization's mailing address or mailing address of the submitter.
AP-204-2
(Rev.12-18/12)
Texas Application for Exemption
– Federal and All Others
• Remove All Staples • TYPE OR PRINT • Do NOT write in shaded areas.
Organizations applying for exemption under one of the categories listed below should check the appropriate box and complete this application.
Our publication, Guidelines to Texas Tax Exemptions (96-1045), includes a description of the additional documentation required for each category of
exemption. For the category you select, be sure to read the requirements listed in the publication. If you send in an application without including the
documentation described in the publication, we will return the application to you with a request for additional information. We are unable to
process incomplete applications.
Special n
ote to non-Texas organizations: Include a le-stamped copy of your organization's formation documents AND a current Certicate of
Existence from the Secretary of State or equivalent ocer in your home state.