Form St-R-13a - Incorporated Nonprofit Nursery School printable pdf download

Form St-R-13a - Incorporated Nonprofit Nursery School

MAINE REVENUE SERVICES

SALES, FUEL & SPECIAL TAX DIVISION

EXEMPTION APPLICATION

INCORPORATED NONPROFIT NURSERY SCHOOL

Name of Corporation_______________________________________________________

Name of Nursery School_____________________________________________________

Physical Location

______________________________________________________

Mailing Address

_______________________________________________________

The statute reads, "licensed, incorporated, nonprofit nursery school".

Is the nursery school incorporated? Yes ___ No ___

Is the nursery school licensed by the Maine Department of Health and Human Services?

Yes___ No ___

Has the nursery school received 501(c) nonprofit status from the IRS? Yes ___ No ___

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 nursery school license from the Maine Department of Health and Human

Services.

3. Copy of the IRS determination letter indication 501(c) nonprofit status

Note: All information contained on this application is subject to VERIFICATION by Maine Revenue Services.

Maine Revenue Services may request additional information or documentation necessary to determine eligibility.

I hereby certify that ______________________________________________________ is an incorporated nonprofit

nursery school licensed by the Maine Department of Health and Human Services. I therefore request that a sales/use

tax exemption certificate be issued to the above organization pursuant to Title 36 MRSA 1760 (43).

Date: _________________________

Signature: _____________________________

Tel:___________________________

Print Name:____________________________

Fed ID# _______________________

Title: _________________________________

Date Facility Opened: ____________________

ST-R-13A (Rev 10/05)

Phone: (207) 624-9693

(207) 287-4477 (Hearing Impaired)

Fax: (207) 287-6628

E-mail: salestax@maine.gov

Form St-R-13a - Incorporated Nonprofit Nursery School