Form St-104-Hm - Sales Tax Exemption On Lodging Accommodations

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Idaho State Tax Commission
ST-104-HM
SALES TAX EXEMPTION ON LODGING ACCOMMODATIONS
TC00140
10-2-95
Claimed by Government Employees Using Credit Card Payment
1 . I am an employee of a
Federal,
Idaho state, or
Idaho local government agency.
2 . I am authorized by my employer to use this credit card for lodging charges at this facility from
_________________ to ________________, for official government purposes:
Date
Date
Visa
Diner's Club
American Express
Master Card
Other ______________________________
Name of Card
_______________________________
Account Number
3 . The credit card company will directly bill, and be paid by, my employer ___________________________________.
Name of Agency
I do not pay charges to this credit card from my own personal funds or from an expense reimbursement.
I certify that all statements I have made on this form are true and correct to the best of my knowledge. I understand that falsification of this
certificate for the purpose of evading payment of tax is a misdemeanor. Other penalties may also apply.
Signature of Government Employee
Work Address
Date
Work Phone
• This form may be reproduced.
• This form is valid only if all information is complete.
• The seller must retain this form.
• This form is valid only for the period of lodging specified above.

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