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Form 6100 - Exemption Certificate From Tax On Occupancy Of Hotel, Motel & Tourist Home Rooms - 1994

STATE OF DELAWARE

FORM 6100

Division of Revenue

EXEMPTION CERTIFICATE

820 N. French Street

Wilmington, Delaware 19801

FROM

TAX ON OCCUPANCY OF

HOTEL, MOTEL & TOURIST HOME ROOMS

CHAPTER 61, TITLE 30, DELAWARE CODE

Note: A Separate Exemption Certificate is Required for Each Occupancy

and for Each Representative or Employee.

PART A - TO BE COMPLETED BY OPERATOR

Name of Hotel, Motel or Tourist Home

Fed. EI or SS Number

Address

City

State

Zip Code

PART B - TO BE COMPLETED BY THE OCCUPANT

This is to certify that I, the undersigned, am a representative of the United States or State of Delaware Governmental Department

or Agency or public school district indicated below; that the charges for the occupancy at the above establishment on the dates

set forth below have been or will be paid for by such Government or public school unit; and that such charges are incurred in the

performance of my official duties as a representative or employee of such Governmental or public school unit.

Name of Individual (Please print or type)

Signature

Government Agency

Title

Address

City

State

Zip Code

Dates of Occupancy

THIS EXEMPTION CERTIFICATE IS TO BE RETAINED BY THE OPERATOR OF THE HOTEL, MOTEL

OR TOURIST HOME AS EVIDENCE OF EXEMPT OCCUPANCY FOR A MINIMUM OF FOUR

CALENDAR YEARS.

Revised 01/1994

Form 6100 - Exemption Certificate From Tax On Occupancy Of Hotel, Motel & Tourist Home Rooms - 1994