Form 6100 - Form 6100 Exemption Certificate From Tax On Occupancy Of Hotel, Motel & Tourist Home Rooms

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STATE OF DELAWARE
FORM 6100
Division of Revenue
820 N. French Street
EXEMPTION CERTIFICATE
Wilmington, Delaware 19801
FROM
TAX ON OCCUPANCY OF
HOTEL, MOTEL & TOURIST HOME ROOMS
CHAPTER 61, TITLE 30, DELAWARE CODE
Note:
A Separate Exemption Certificate is Required for Each Occupancy
and for Each Representative or Employee.
PART A - TO BE COMPLETED BY OPERATOR
Name of Hotel, Motel or Tourist Home
Fed. EI or SS Number
Address
Address
City
State
Zip Code
PART B - TO BE COMPLETED BY THE OCCUPANT
This is to certify that I, the undersigned, am a representative of the United States or State
of Delaware Governmental Department or Agency or public school district indicated below, that
the charges for
the occupancy at the
above establishment on
the dates set forth below have
been or will be paid for by such
Government or public school unit; and that such charges are
incurred in the performance
of my official
duties as a
representative or
employee of such
Governmental or public school unit.
Name of Individual (Please print or type)
Signature
Government Agency
Title
Address
City
State
Zip Code
Dates of Occupancy
MOTEL
THIS EXEMPTION
CERTIFICATE IS TO
BE RETAINED BY THE
OPERATOR OF THE HOTEL,
OR TOURIST HOME AS EVIDENCE OF EXEMPT OCCUPANCY FOR A MINIMUM OF FOUR CALENDAR YEARS.

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