Form St-R-04 - Pplication For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Educational Organization
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1S T A T E O F M A I N E
M A I N E R E V E N U E S E R V I C E S
ADMINISTRATIVE & FINANCIAL
2 4
S T A T E H O U S E S T A T I O N
SERVICE
,
A U G U S T A
M A I N E
REBECCA M. WYKE
0 4 3 3 3 - 0 0 24
COMMISSIONER
John Elias Baldacci
JEROME D. GERARD
GOVERNOR
ACTONG EXECTUTIVE DIRECTOR
APPLICATION FOR SALE/USE TAX EXEMPTION CERTIFICATE
FOR AN INCORPORATED NONPROFIT EDUCATIONAL ORGANIZATION
Name of Corporation
_______________________________________________________
Name of Educational Organization
______________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
_______________________________________________________
_______________________________________________________
The statute reads,
"Incorporated nonprofit education organizations which are receiving, or have received, funding from the Department of
Education, and which provides educational programs specifically designed for teaching young people how to make decisions about drugs, alcohol and
interpersonal relationships at a residential camp setting."
Is the educational organization incorporated? Yes ___ No ___
Send a copy of the articles of incorporation
Has the educational organization received 501(c) nonprofit status from the IRS? Yes ___ No ___
Send a copy of the IRS determination letter indicating 501(c) nonprofit status
IN ORDER TO PROCESS THE APPLICATION THE FOLLOWING MUST BE INCLUDED
1. Copy of the Articles of Incorporation, as well as a copy of the Constitution and/or By-law
2. Copy of the IRS determination letter indicating 501(c) nonprofit status
3. Proof of funding from the Department of Education
I hereby certify that ______________________________________________________ is an incorporated
nonprofit educational organization. I therefore request that a sales/use tax exemption certificate be issued to the
above organization pursuant to Title 36 MRSA 1760 (59).
Date:
Signature: _________________________________________
Tel:
Print Name: _______________________________________
Fed ID:
Title: _____________________________________________
Date Facility Opened: ________________________________
ST-R-04
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E A R I N G
M P A I R E D
H O N E
E-mail:
sales.tax@state.me.us
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