Form St-A-103 - Affidavit Regarding Purchases Of Certain Products For Use In Commercial Agricultural Production, Commercial Fishing, Aquacultural Production And Animal Agriculture

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MAINE REVENUE SERVICES
SALES/EXCISE TAX DIVISION
AFFIDAVIT REGARDING PURCHASES OF CERTAIN PRODUCTS FOR USE IN
COMMERCIAL AGRICULTURAL PRODUCTION, COMMERCIAL FISHING,
AQUACULTURAL PRODUCTION AND ANIMAL AGRICULTURE
I present this affidavit to ____________________________________ and certify under penalty of perjury that
purchases made by me from this retailer constitute:
[ ] a. Seed, fertilizers, defoliants, pesticides, or weed killers to be used by me in commercial agricultural
production. “Commercial agricultural production” means commercial production of crops, plants, trees,
compost and livestock.
[ ] b. Bait for commercial fisherman.
[ ] c. Feed, hormones, pesticides, antibiotics or medicine to be used by me in aquacultural production.
[ ] d. Breeding stock, semen, embryos, feed, hormones, antibiotics, medicine, pesticides, or litter for use in
animal agricultural production, including the raising and keeping of equines.
[ ] e. Organic bedding materials for farm animals.
[ ] f. Antiseptics and cleaning agents to be used by me in commercial animal agricultural production.
[ ] g. Materials to be used in the construction, repair or maintenance of an animal waste storage facility.
I declare these purchases are exempt from Maine sales and use tax. I agree to assume full liability for
payment to the State of Maine of any use taxes, together with penalties and interest that may later be
determined to be due on any purchases covered by this affidavit because of a taxable use of the property.
_________________________________
_______________________________________
NAME OF PURCHASER
DATE
_________________________________
_______________________________________
SIGNATURE
TITLE
NOTICE TO RETAILERS: Retailers making exempt sales covered by this certificate must appropriately mark or stamp all invoices to
indicate whether they are exempt sales.
Misuse of Affidavit
Purchasers who avoid payment of tax through deliberate misuse of this affidavit of exemption may be subject to criminal prosecution.
ST-A-103
08/2016

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