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Form Str-Ptdz-Supp - Application For Refund Of Sales Or Use Tax Construction Of Realty For Pine Tree Development Zone Business

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

APPLICATION FOR REFUND OF SALES OR USE TAX

Construction of Realty for Pine Tree Development Zone Business

To ensure prompt processing of this application, please fill in all applicable lines and attach all

pertinent information.

Name and address:

_______________________________________

Social Security #________________________

_______________________________________

Federal ID #___________________________

_______________________________________

Contact Person ________________________

Telephone # _________________________

AMOUNT OF REFUND REQUEST $___________________

Note: If the Pine Tree Development Zone business will have both qualifying and non-qualifying

employees working in the facility you have constructed, your refund request may be pro-rated

accordingly.

WHAT SHOULD BE INCLUDED WITH THE APPLICATION?

Form STR-PTDZ-Supp.

Schedule of purchases to support claim.

Refunds disallowed when an application is received more than 3 years after the materials are incorporated into

the realty of the PTDZ business!

Copy of exemption certificate issued by Maine Revenue to PTDZ business.

Description of construction project.

Any other pertinent information to support claim.

I certify under the pains and penalty of perjury that the materials on which tax was paid were

incorporated into real property that has been placed into use directly and primarily in a qualified Pine

Tree Development Zone business activity and that the statements made in this application and any

attachments thereto are true, accurate and complete to the best of my knowledge and belief.

Signature _______________________________

Date _______________________________

Print Name _____________________________

Title _______________________________

STR-PTDZ

6/2005

Form Str-Ptdz-Supp - Application For Refund Of Sales Or Use Tax Construction Of Realty For Pine Tree Development Zone Business