MAINE REVENUE SERVICES
SALES/EXCISE TAX DIVISION
AFFIDAVIT REGARDING PURCHASES OF CERTAIN PRODUCTS FOR USE IN SILVICULTURE,
AGRICULTURE, FISHING, AQUACULTURE AND ANIMAL AGRICULTURE.
I present this affidavit to ____________________________________ and certify under penalty of perjury that
purchases made by me from this retailer:
[ ] a. Constitute seed, fertilizers, defoliants, pesticides, rodenticides, insecticides, fungicides or weed killers to
be used by me in the commercial production of a silvicultural crop.
[ ] b. Constitute seed, fertilizers, defoliants, pesticides, rodenticides, insecticides, fungicides or weed killers to
be used by me in the commercial production of an agricultural crop.
[ ] c. Constitute feed, hormones, pesticides, antibiotics or medicine to be used by me in aquacultural produc-
[ ] d. Constitute breeding stock, semen, embryos, feed, hormones, antibiotics, medicine, pesticides, or litter to
be used by me in animal agricultural production, including the raising and keeping of equines.
[ ] e. Constitute bait for commercial fisherman.
[ ] f. Constitute materials to be used by me in the construction, repair or maintenance of an animal waste stor-
[ ] g. Constitute antiseptics and cleaning agents to be used by me in commercial animal agricultural produc-
[ ] h. Constitute organic bedding materials for farm animals.
I believe 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
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.