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Form St-R-18 - Incorporated Nonprofit Historical Societies, Museums And Certain Memorial Foundations (2005)

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

EXEMPTION APPLICATION

( ) INCORPORATED NONPROFIT MEMORIAL FOUNDATIONS OR

( ) AN INCORPORATED NONPROFIT HISTORICAL SOCIETY OR

( ) AN INCORPORATED NONPROFIT MUSEUM

Name of Corporation

______________________________________________________

Name of Organization

______________________________________________________

Physical Location

______________________________________________________

Mailing Address

______________________________________________________

The statute reads, "Historical societies, museums and certain memorial foundations. Sales to

incorporated nonprofit memorial foundations that primarily provide cultural programs free to the

public, historical societies and museums. [2001, c. 439, Pt. PPP, §1 (amd); §2 (aft).]

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

3. Please forward any publications issued by your organization which would provide details

regarding purpose, mission and/or services offered, if applicable.

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 memorial foundation, historical society or museum. I therefore request that a

sales/use tax exemption certificate be issued to the above organization pursuant to Title 36 MRSA 1760

(42).

Date: _________________________

Signature: ____________________________

Tel:

Print Name: ___________________________

Fed ID:

Title: __________________________________

Date Facility Opened: _____________________

ST-R-18 (Rev 10/05)

Phone: (207) 624-9693

TDD: (888) 577-6690

Fax: (207) 287-6628

E-mail: salestax@maine.gov

Form St-R-18 - Incorporated Nonprofit Historical Societies, Museums And Certain Memorial Foundations (2005)