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Form Str-Cme - Sales, Fuel & Special Tax Division Request For Connectme Sales & Use Tax Reimbursement

STATE OF MAINE

MAINE REVENUE SERVICES

24 STATE HOUSE STATION

AUGUSTA, MAINE

04333-0024

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

REQUEST FOR CONNECTME SALES & USE TAX REIMBURSEMENT

Maine Revenue Service Rule No. 324

To ensure prompt processing of this application, please fill in all applicable lines and attach all pertinent

information.

Name__________________________________________ Social Security # _____________________

Address________________________________________ Federal ID # _________________________

City/State/Zip ___________________________________ Contact Person ____________________

Telephone # _____________________________________

AMOUNT OF REFUND REQUEST $_______________________ (Additional information may be required)

WHAT SHOULD BE INCLUDED WITH THE APPLICATION?

1. Original or certified copy of the ConnectME Authority Certificate of Qualification with attestation that the

Machinery and Equipment for which the certificate was issued continues to be used Primarily in the development of

an Advanced Communications Technology Infrastructure in a Qualifying ConnectME Zone.

2. Proof tax was paid. (copies of invoices, etc.)

3. Any other possible pertinent information.

* Refunds are disallowed when an application is received more than 3 years after the date of purchase.

* This refund request is considered incomplete until all requested additional information has been timely

received.

* Failure to provide additional information could result in a denial of your request.

I attest that the Machinery and Equipment for which the Certificate of Qualification was issued continues to be used

Primarily in the development of an Advanced Communications Technology Infrastructure in a Qualifying

ConnectME Zone. I certify under the pains and penalty of perjury that the statements made in this application and

any attachments thereto are true, accurate, and complete to the best of my knowledge and belief.

Signature _______________________________ Date _______________________________

Print Name _____________________________ Title _______________________________

Mail Application & Documentation to:

Maine Revenue Services

Sales, Fuel & Special Tax Division

P.O. Box 1065

Augusta, ME 04332-1065

STR-CME 10/10

Phone: (207)624-9693

NexTalk 1-888-577-6690

Fax: (207)287-6628

Form Str-Cme - Sales, Fuel & Special Tax Division Request For Connectme Sales & Use Tax Reimbursement