Form St-R-12 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Organization Engaged Primarily In Providing Support For Single-Parent Families
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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 ORGANIZATION ENGAGED PRIMARILY
IN PROVIDING SUPPORT FOR SINGLE-PARENT FAMILIES
Name of Corporation
_______________________________________________________
Name of Organization
_______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
_______________________________________________________
_______________________________________________________
The statute reads, “Incorporated nonprofit providers of certain support systems for single-parent families. Sales
to incorporated nonprofit organizations engaged primarily in providing support systems for single-parent
families for the development of psychological and economic self-sufficiency.”
Is the organization incorporated? Yes ___ No ___
Send a copy of the articles of incorporation
Has the 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
I hereby certify that ______________________________________________________ is an incorporated
nonprofit organization providing support systems for single-parent families. I therefore request that a sales/use
tax exemption certificate be issued to the above organization pursuant to Title 36 MRSA 1760 (66).
Date:
Signature: ___________________________________________
Tel:
Printed Name: ________________________________________
Fed ID:
Title: _______________________________________________
Date Facility Opened:__________________________________
ST-R-12
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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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