Michigan Sales And Use Tax Contractor Eligibility Statement Form For Qualified Nonprofit Hospitals, Nonprofit Housing, Church Sanctuaries, And Pollution Control Facilities Exemptions printable pdf download

Michigan Sales And Use Tax Contractor Eligibility Statement for Qualified

Nonprofit Hospitals, Nonprofit Housing, Church Sanctuaries, and Pollution Control

Facilities Exemptions

A real property contractor may use this form to obtain a statement from the property owner that materials to be

affixed to and made a structural part of certain real property qualify for exemption based on facts within the control

of the property owner. The property owner should complete the form and return it to the contractor who will

submit this form to the supplier along with the Sales and Use Tax Certificate of Exemption at the time of purchase.

Nothing in this statement should be construed to relieve a contractor from tax liability if it is found that the subject

property does not qualify for the exemption.

PROPERTY OWNER STATES that materials will be affixed to and made a structural part of its real property and that

the property owner is one of the following entities (Check the box that applies):

Nonprofit Hospital [ ]

Check this box only if the property owner meets the definition of hospitals contained in Revenue Administrative Bulletin 99-2 and

no benefit will inure directly or indirectly to a private individual.

Qualified Nonprofit Housing [ ]

Check this box only if the property owner is qualified under section 15a of the state housing development authority act of 1966.

(Attach a copy of the Michigan Housing Development Authority ruling.)

Qualified Water Pollution Control Facility [ ]

(Attach a copy of the exemption certificate granted by the Michigan State Tax Commission.)

Qualified Air Pollution Control Facility [ ]

(Attach a copy of the exemption certificate granted by the Michigan State Tax Commission.)

Church Sanctuary [ ]

Check this box only if the property owner is a religious organization qualified under section 501(c)(3) of the internal revenue code

and the material will be affixed to the designated exempt portion of the building defined by law as a sanctuary that is or will upon

completion be used predominantly and regularly for religious worship. (Attach verification of 501(c)(3) status from the Internal

Revenue Service)

Optional: A percentage can be used to determine the exempt portion of a piece of equipment or an order

of materials to be used in taxable and nontaxable areas. The percentage is a fraction, the numerator of

which is the square footage of the sanctuary and the denominator is the square footage of the entire

building.

Square footage of sanctuary _____________________.

Square footage of entire building _____________________.

The percentage of the building that constitutes that sanctuary is _____________________.

(Rounded to the nearest one-hundredth of a percent)

The undersigned property owner states that the attached documentation (if applicable) and the

representations on this form are true and acknowledges that the contractor, the seller, and the State of

Michigan may rely upon this form to determine qualifications for tax exemption.

Property Owner Street Address __________________________________

Area Code/Telephone No

_________________________________

City State Zip Code

___________________________________

Signature and Title

___________________________________

Date Signed

___________________________________

Michigan Sales And Use Tax Contractor Eligibility Statement Form For Qualified Nonprofit Hospitals, Nonprofit Housing, Church Sanctuaries, And Pollution Control Facilities Exemptions

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