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Form St-R-41 - Exemption Application Incorporated Nonprofit Organization Or Their Affiliates Whose Purpose Is To Provide Literacy Assistance

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

EXEMPTION APPLICATION

INCORPORATED NONPROFIT ORGANIZATION OR THEIR AFFILIATES WHOSE

PURPOSE IS TO PROVIDE LITERACY ASSISTANCE

Name of Corporation_______________________________________________________

Name of Organization ______________________________________________________

Physical Location

_______________________________________________________

Mailing Address

_______________________________________________________

The statute reads, "incorporated nonprofit organization or their affiliates whose purpose is to

provide literacy assistance".

Is the organization incorporated? Yes ___ No ___

Has the organization 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 IRS determination letter indicating 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 literary assistance organization. I therefore request that a sales/use tax

exemption certificate be issued to the above organization pursuant to Title 36 MRSA 1760 (16).

Date:

Signature:_______________________________

Tel:

Print Name: _____________________________

Fed ID: _______________________

Title: ___________________________________

Date Facility Opened: ______________________

ST-R-41 (Rev 10/05)

Phone: (207) 624-9693

TDD: (888) 577-6690

Fax: (207) 287-6628

E-mail: salestax@maine.gov

Form St-R-41 - Exemption Application Incorporated Nonprofit Organization Or Their Affiliates Whose Purpose Is To Provide Literacy Assistance