Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Day Care Center printable pdf download

Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Day Care Center

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 DAY CARE CENTER

Name of Corporation

_______________________________________________________

Name of Day Care Ctr.

_______________________________________________________

Physical Location

_______________________________________________________

Mailing Address

_______________________________________________________

The statute reads, "licensed, incorporated, nonprofit day care center."

Is the day care center incorporated? Yes ___ No ___

Send a copy of the articles of incorporation

Is the day care center licensed by the Department of Behavioral and Developmental Services?

Yes___ No ___

Send a copy of the license received by the Department of Behavioral and Developmental

Services!

Has the day care center 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 day care center license from the Department of Behavioral and Developmental Services

3. Copy of the IRS determination letter indication 501(c) nonprofit status

I hereby certify that ______________________________________________________ is an incorporated

nonprofit day care center licensed by the Department of Behavioral and Developmental Services. I therefore

request that a sales/use tax exemption certificate be issued to the above organization pursuant to Title 36 MRSA

1760 (43).

Date:

Signature: ___________________________________________

Tel:

Print Name: __________________________________________

Fed ID# _______________________

Title: _______________________________________________

Fed ID:

Date Facility Opened: __________________________________

ST-R-13

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A X

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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 Day Care Center

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