Form St-R-33 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Community Action Agency

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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 COMMUNITY ACTION AGENCY
Name of Corporation
_______________________________________________________
Name of Community Action Agency ______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
_______________________________________________________
The statute reads, "Community action agencies. Sales to community action agencies
designated in accordance with Title 22, section 5324, except sales, storage or use for activities
that are mainly commercial enterprises.” PL 1995, c. 281, §15 (amd).
IN ORDER TO PROCESS THE APPLICATION THE FOLLOWING MUST BE INCLUDED
1. Copy of your letter from the Bureau of Child and Family Services designating the organization as a
community action agency.
I hereby certify that ______________________________________________________ is an incorporated
nonprofit community action agency. I therefore request that a sales/use tax exemption certificate be issued to
the above organization pursuant to Title 36 MRSA 1760 (49).
Date:
Signature: ___________________________________________
Tel:
Print Name: __________________________________________
Fed ID:
Title: _______________________________________________
Date Facility Opened: __________________________________
ST-R-33
P
RINTED ON RECYCLED PAPER
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A X
( 2 0 7 ) 2 8 7 - 4 4 7 7 ( H
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P
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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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