Form St-R-13 - Incorporated Nonprofit Day Care Center printable pdf download

Form St-R-13 - Incorporated Nonprofit Day Care Center

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

EXEMPTION APPLICATION

INCORPORATED NONPROFIT DAY CARE CENTER

Name of Corporation______________________________________________________

Name of Day Care Ctr._____________________________________________________

Physical Location

_____________________________________________________

Mailing Address

_____________________________________________________

_______________________________________________________

The statute reads, "licensed, incorporated, nonprofit day care center."

Is the day care center incorporated? Yes ___ No ___

Is the day care center licensed by the Maine Department of Health and Human Services?

Yes___ No ___

Has the day care center received 501(c) nonprofit status from the IRS? Yes ___ No ___

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 day care center license from the Maine Department of Health and Human

Services

3. Copy of the IRS determination letter indication 501(c) nonprofit status

Note: All information contained on this application is subject to VERIFICATION by Maine Revenue

Services.

Maine Revenue Services may request additional information or documentation necessary to determine

eligibility

I hereby certify that ______________________________________________________ is an

incorporated nonprofit day care center licensed by the Maine Department of Health and Human Services.

I therefore request that a sales/use tax exemption certificate be issued to the above organization pursuant

to Title 36 MRSA 1760 (43).

Date:

Signature:_______________________________

Tel:

Print Name: _____________________________

Fed ID# _______________________

Title:____________________________________

Date Facility Opened: ______________________

ST-R-13 (Rev 10/05)

Phone: (207) 624-9693

(207) 287-4477 (Hearing Impaired)

Fax: (207) 287-6628

E-mail: salestax@maine.gov

Form St-R-13 - Incorporated Nonprofit Day Care Center