Form St-R-24 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Ambulance Service
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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 AMBULANCE SERVICE
Name of Corporation
_______________________________________________________
Name of Ambulance Service_______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
______________________________________________________
_______________________________________________________
The statute reads, "Incorporated nonprofit ambulance service."
Is the ambulance service incorporated? Yes ___ No ___
Send a copy of the articles of incorporation
Has the ambulance service 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 ambulance service. I therefore request that a sales/use tax exemption certificate be issued to the above
organization pursuant to Title 36 MRSA 1760 (26) and 08-125 CMR 302..
Date:
Signature: ___________________________________________
Tel:
Print Name: __________________________________________
Fed ID:
Title: _______________________________________________
Date Facility Opened: __________________________________
ST-R-24
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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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