Form St-R-39 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Area Agencies On Aging
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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 AREA AGENCIES ON AGING
Name of Corporation
_______________________________________________________
Name of Area Agencies on Aging __________________________________________________
Mailing Address
_______________________________________________________
_______________________________________________________
_______________________________________________________
The statute reads, Certain meals, Sales of meals: C. By hospitals, schools, long-term care facilities, food
contractors and restaurants to incorporated nonprofit area agencies on aging for the purpose of providing meals
to the elderly; and PL 1991c c, 846, §19 (amd)."
Is the area agency on aging incorporated? Yes ___ No ___
Send a copy of the articles of incorporation!
Has the area agency on aging 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 area agency on aging. I therefore request that a sales/use tax exemption certificate be issued to the
above organization pursuant to Title 36 MRSA 1760 (6c).
Date:
Signature: ___________________________________________
Tel:
Print Name: __________________________________________
Fed ID:
Title: ________________________________________________
Date Facility Opened: ___________________________________
ST-R-39
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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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