Application For Sale/use Tax Exemption Certificate For A Nonprofit Church Affiliated Residential Home printable pdf download

Application For Sale/use Tax Exemption Certificate For A Nonprofit Church Affiliated Residential Home

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 A NONPROFIT CHURCH AFFILIATED RESIDENTIAL HOME

Name of Corporation

______________________________________________________

Name of Church Affiliated

Residential Home for Adults ______________________________________________________

Physical Location

______________________________________________________

Mailing Address

______________________________________________________

The statute reads, "Certain church affiliated residential homes. Sales to any church affiliated nonprofit

organization which operates, under a charter granted by the Legislature, a residential home for adults. PL 1983,

c. 562 (ral).

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 Charter granted by the Legislature

2. Copy of the IRS determination letter indicating 501(c) nonprofit status

3. Please forward any publications issued by your organization which would provide details regarding purpose,

mission and/or services offered, if applicable.

I hereby certify that ______________________________________________________ is a nonprofit church

affiliated residential home. I therefore request that a sales/use tax exemption certificate be issued to the above

organization pursuant to Title 36 MRSA 1760 (44).

Date:

Signature: ___________________________________________

Tel:

Print Name: __________________________________________

Fed ID:

Title: _______________________________________________

Date Facility Opened: __________________________________

ST-R-38

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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 A Nonprofit Church Affiliated Residential Home

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