Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Residential Care Facility printable pdf download

Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Residential Care Facility

S 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 RESIDENTIAL CARE FACILITY

Name of Corporation

_______________________________________________________

Name of Residential Care Facility _____________________________________________________

Physical Location

_______________________________________________________

Mailing Address

_______________________________________________________

The statute reads, "Incorporated nonprofit residential care facilities licensed by the Department of Behavioral and

Developmental Services,"

Is the residential care facility incorporated? Yes ___ No ___

Send a copy of the articles of incorporation

Has the residential care facility 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. Copy of license issued by the State of Maine Department of Behavioral and Developmental Services

I hereby certify that ______________________________________________________ is an incorporated

nonprofit residential care facility. I therefore request that a sales/use tax exemption certificate be issued to the

above organization pursuant to Title 36 MRSA 1760 (16).

Date:

Signature: ___________________________________________

Tel:

Print Name: __________________________________________

Fed ID# _______________________

Title: _______________________________________________

Date Facility Opened: __________________________________

ST-R-10

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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

Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Residential Care Facility

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