Form St-R-17 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Emergency Shelter And Feeding Organizations

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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 EMERGENCY SHELTER
AND FEEDING ORGANIZATIONS
Name of Corporation
_______________________________________________________
Name of Emergency Shelter_______________________________________________________
or Feeding Organization
_______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
______________________________________________________
_______________________________________________________
The statute reads, "Emergency shelter and feeding organizations. Beginning October 1, 1996, sales to
incorporated nonprofit organizations that provide free temporary emergency shelter or food for underprivileged
individuals in this State; PL. RR 1995, c. 2, §95 (cor)."
Is the emergency shelter and feeding organization incorporated? Yes ___ No ___
Send a copy of the articles of incorporation!
Has the emergency shelter and feeding 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
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 an incorporated
nonprofit emergency shelter and feeding organization. I therefore request that a sales/use tax exemption
certificate be issued to the above organization pursuant to Title 36 MRSA 1760 (47-A).
Date:
Signature: ___________________________________________
Tel:
Print Name: __________________________________________
Fed ID:
Title: _______________________________________________
Date Facility Opened: __________________________________
ST-R-17
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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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