Form St-R-06 - Application For Sale/use Tax Exemption Certificate Community Mental Health Facility Or Community Mental Retardation Facility Or Community Substance Abuse Facility

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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
(
) COMMUNITY MENTAL HEALTH FACILITY OR
(
) COMMUNITY MENTAL RETARDATION FACILITY OR
(
) COMMUNITY SUBSTANCE ABUSE FACILITY
Name of Corporation
_________________________________________________
Name of Organization
_________________________________________________
Physical Location
_________________________________________________
Mailing Address
_________________________________________________
_________________________________________________
_________________________________________________
The statute reads, "Community mental health facilities, community mental retardation facilities and community
substance abuse facilities. Sales to mental health facilities, mental retardation facilities, or substance abuse
facilities that are:
A. Contractors under or receiving support under the Federal Community Mental Health Center Act, or its
successors; or
B. Receiving support from the Department of Behavioral and Developmental Services pursuant to Title 5,
section 20005 or Title 34-B, section 3604, 5433 or 6204. c. 708, PL 1999, PL 1995, c. 560, Pt. K, §82 (amd); §83
(aff).”
IN ORDER TO PROCESS THE APPLICATION THE FOLLOWING MUST BE INCLUDED
1. Proof of receiving support from the Department of Behavioral and Development Services
2. Documentation that indicates the purpose of organization
I hereby certify that ______________________________________________________ is a mental health,
mental retardation facility or a substance abuse facility. I therefore request that a sales/use tax
exemption certificate be issued to the above organization pursuant to Title 36 MRSA 1760 (28).
Date:
Signature: _____________________________________
Tel: __________________________
Printed Name: __________________________________
Fed ID: _______________________
Title: __________________________________________
Date Facility Opened: ____________________________
ST-R-06
P
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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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