Form Str-23 - Application For Sale/use Tax Exemption Certificate For An Incorporated Nonprofit Corporation For The Sole Purpose Of Conducting Medical Research Or For The Purpose Of Establishing

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S T A T E O F M A I N E
M A I N E R E V E N U E S E R V I C E S
ADMINISTRATIVE & FINANCIAL
2 4
S T A T E H O U S E S T A T I O N
SERVICE
,
A U G U S T A
M A I N E
REBECCA M. WYKE
0 4 3 3 3 - 0 0 24
COMMISSIONER
John Elias Baldacci
JEROME D. GERARD
GOVERNOR
ACTONG EXECTUTIVE DIRECTOR
APPLICATION FOR SALE/USE TAX EXEMPTION CERTIFICATE
FOR AN INCORPORATED NONPROFIT CORPORATION FOR THE SOLE PURPOSE
OF CONDUCTING MEDICAL RESEARCH OR FOR THE PURPOSE OF
ESTABLISHING AND MAINTAINING LABORATORIES FOR SCIENTIFIC STUDY AND
INVESTIGATION IN THE FIELD OF BIOLOGY OR ECOLOGY OR OPERATING EDUCATIONAL
TELEVISION OR RADIO STATIONS
Name of Corporation
_______________________________________________________
Name of Institution
_______________________________________________________
Physical Location
_______________________________________________________
Mailing Address
_______________________________________________________
______________________________________________________
_______________________________________________________
The statute reads, "institutions incorporated as nonprofit corporations for the sole purpose of conducting
medical research or for the purpose of establishing and maintaining laboratories for scientific study and
investigations in the field of biology or ecology or operating educational television or radio stations."
Is the institution incorporated? Yes ___ No ___
Send a copy of the articles of incorporation
Has the institution received 501(c) nonprofit status from the IRS? Yes ___ No ___
Send a copy of the IRS determination letter indicating 501(c) nonprofit status
IN ORDER TO PROCESS THE APPLICATION THE FOLLOWING MUST BE INCLUDED
1. Copy of the Articles of Incorporation, as well as a copy of the Constitution and/or By-law
2. Copy of the IRS determination letter indicating 501(c) nonprofit status
I hereby certify that ______________________________________________________ is an incorporated
nonprofit institution. I therefore request that a sales/use tax exemption certificate be issued to the above
organization pursuant to Title 36 MRSA 1760 (16).
Date:
Signature: ___________________________________________
Tel:
Print Name: __________________________________________
Fed ID:
Title: _______________________________________________
Date Facility Opened: __________________________________
STR-23
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E A R I N G
M P A I R E D
H O N E
E-mail:
sales.tax@state.me.us

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