Amusement Tax Exemption Notification Form - City Of Chicago Department Of Revenue (Page 2 of 2) in pdf

Section 2: Reasons for Exemption

In the space provided, please state all reasons why the amusement referenced above is exempt under the Chicago Amusement Tax Ordinance.

Attach an additional sheet, if necessary.

___

_________

________

Section 3: Type of Exemption

Please check the one that best supports your claim for exemption.

Exemption is being claimed pursuant to Section 4-156-020B(5)(a) through (d)(not-for-profit organizations) of the Chicago Amusement

Ordinance.

Exemption is being claimed pursuant to Section 4-156-020B(5)(e) of the Chicago Amusement Tax Ordinance (armed services

exemption).

If you are claiming an exemption pursuant to this section, please answer the following:

Were all sponsors or conductors of the amusement organized in the State of Illinois?

Yes

C. Exemption is being claimed pursuant to Section 4-156-020(B(5)(f) of the Chicago Amusement Tax Ordinance (exemption for Police and

Fire Departments of any political subdivision of Illinois).

If you are claiming an exemption pursuant to this section, please answer the following:

Were all sponsors or conductors created and maintained for the purpose of benefiting their members, dependents, or heirs?

Yes

D. Exemption being claimed pursuant to Section 4-156-020B(5)(g) of the Chicago Amusement Tax Ordinance (exemption for maintaining

symphony orchestras, opera performances, artistic and musical presentations).

If you are claiming an exemption pursuant to this section, please answer the following:

Is the sponsor or conductor of the amusement organized solely for the purpose of maintaining symphony orchestras, opera

performances and artistic presentations, including but not limited to, musical presentations?

Yes

Does the sponsor or conductor receive substantial support from voluntary contributions?

Yes

Is the sponsor or conductor a not-for-profit institution where no part of the net earnings inure to the benefit of any private

shareholder or person?

Yes

Is the sponsor or conductor the bearer of all risk of financial loss from this amusement?

Yes

Is the amusement limited to an engagement of not more than eight calendar days over the course of a calendar year?

Yes

If you answered No to question 4 or 5, please answer the following:

Is the sponsor or conductor substantially and materially involved in the production and performance of the amusement?

Yes

Section 4: Supporting Documents Required

Copies of the tax exempt letters from the Internal Revenue Service and the State of Illinois for all exempted sponsors or conductors of

the amusement.

Copies of (a) all fully-executed contracts between the sponsor or conductor of the amusement and any other entity, i.e., theater or venue

contracts, performer contracts and any other relevant contracts. Please enclose copies of all fully-executed riders, attachments,

addendums or schedules to all contracts, as well.

C. Copy of an advertisement, flyer or program regarding the amusement.

I hereby certify, under penalties of perjury, that this is a true and correct reporting of all the facts arising in connection with this

exemption notification.

Organization

_____

Signature

Name (Please Print)

Title

Date

Phone No.

Amusement Tax Exemption Notification Form - City Of Chicago Department Of Revenue Page 2

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