Form ST-A-105 "Affidavit of Exemption for 28-day Continuous Rental at a Hotel, Rooming House, Tourist Camp, or Trailer Camp" - Maine

What Is Form ST-A-105?

This is a legal form that was released by the Maine Department of Administrative and Financial Services - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Maine Department of Administrative and Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ST-A-105 by clicking the link below or browse more documents and templates provided by the Maine Department of Administrative and Financial Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form ST-A-105 "Affidavit of Exemption for 28-day Continuous Rental at a Hotel, Rooming House, Tourist Camp, or Trailer Camp" - Maine

Download PDF

Fill PDF online

Rate (4.4 / 5) 63 votes
Page background image
MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
AFFIDAVIT OF EXEMPTION
For 28-day continuous rental at a hotel, rooming house, tourist camp, or trailer camp
36 M.R.S. § 1760(20) of the Maine Sales and Use Tax Law provides a sales tax exemption for:
Rental charged to the following:
A. An individual who resides continuously for 28 days or more at any one hotel, rooming house, tourist camp or
trailer camp, if the individual does not maintain a primary residence at some other location or is residing away
from the individual’s primary residence in connection with employment or education; and
B. A person that rents living quarters for 28 or more consecutive days, when the living quarters are used by the
person’s employees in connection with their employment.
Any tax paid by an individual or person specified in paragraph A or B during the initial 28-day period must be
refunded by the retailer. If the tax has been reported and paid to the State by the retailer, it may be taken as a
credit by the retailer on the return filed by the retailer covering the month in which the refund was made.
NOTE: Any break in the rental period will result in a new stay. A new affidavit must be completed for each stay for
which a tenant or employer claims a sales tax exemption.
PART A – STATEMENT BY TENANT OR EMPLOYER
I,
, hereby certify that the continuous rental of living quarters,
provided by _______________________________________________ is exempt from sales tax for the following reason:
 Rental of living quarters constitutes my primary residence ("Primary residence" means the residence maintained at
the location in which you are domiciled. "Domicile" is the place where you have your true, fixed and permanent home,
which is typically the location where you have the most legal or other ties (driver's license, voting registration, vehicle
registration, ownership of real property, enrollment of children in school systems, etc.)
Tenant: Please complete the following questionnaire:
My previous address was
______________________________________________________________________
Date that I left previous address ______________________________________________________________________
Current mailing address
______________________________________________________________________
Driver’s License Number
____________________________
Vehicle Plate Number ___________________
Current Telephone Number
______________________________________________________________________
Social Security Number
_______________________________
Date of Birth _________________________
 Rental is in connection with education ("In connection with education" means in connection with education from
an accredited secondary school or college at which you are enrolled in a diploma or degree program.)
Tenant: A statement from the school that you are enrolled in such a program must be given to the provider.
 Rental is in connection with employment
Tenant/Employer: A statement from the employer that the travel is required by employment and the purpose of the
employment must be given to the provider.
I declare under the penalties of perjury that the statements made herein are true to the best of my knowledge and belief.
Signature of Tenant or Employer Representative
Date
ST-A-105
11/1/2017
MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
AFFIDAVIT OF EXEMPTION
For 28-day continuous rental at a hotel, rooming house, tourist camp, or trailer camp
36 M.R.S. § 1760(20) of the Maine Sales and Use Tax Law provides a sales tax exemption for:
Rental charged to the following:
A. An individual who resides continuously for 28 days or more at any one hotel, rooming house, tourist camp or
trailer camp, if the individual does not maintain a primary residence at some other location or is residing away
from the individual’s primary residence in connection with employment or education; and
B. A person that rents living quarters for 28 or more consecutive days, when the living quarters are used by the
person’s employees in connection with their employment.
Any tax paid by an individual or person specified in paragraph A or B during the initial 28-day period must be
refunded by the retailer. If the tax has been reported and paid to the State by the retailer, it may be taken as a
credit by the retailer on the return filed by the retailer covering the month in which the refund was made.
NOTE: Any break in the rental period will result in a new stay. A new affidavit must be completed for each stay for
which a tenant or employer claims a sales tax exemption.
PART A – STATEMENT BY TENANT OR EMPLOYER
I,
, hereby certify that the continuous rental of living quarters,
provided by _______________________________________________ is exempt from sales tax for the following reason:
 Rental of living quarters constitutes my primary residence ("Primary residence" means the residence maintained at
the location in which you are domiciled. "Domicile" is the place where you have your true, fixed and permanent home,
which is typically the location where you have the most legal or other ties (driver's license, voting registration, vehicle
registration, ownership of real property, enrollment of children in school systems, etc.)
Tenant: Please complete the following questionnaire:
My previous address was
______________________________________________________________________
Date that I left previous address ______________________________________________________________________
Current mailing address
______________________________________________________________________
Driver’s License Number
____________________________
Vehicle Plate Number ___________________
Current Telephone Number
______________________________________________________________________
Social Security Number
_______________________________
Date of Birth _________________________
 Rental is in connection with education ("In connection with education" means in connection with education from
an accredited secondary school or college at which you are enrolled in a diploma or degree program.)
Tenant: A statement from the school that you are enrolled in such a program must be given to the provider.
 Rental is in connection with employment
Tenant/Employer: A statement from the employer that the travel is required by employment and the purpose of the
employment must be given to the provider.
I declare under the penalties of perjury that the statements made herein are true to the best of my knowledge and belief.
Signature of Tenant or Employer Representative
Date
ST-A-105
11/1/2017
PAGE 2
PART B – STATEMENT BY RETAILER
First day of current rental period (mm/dd/yy):
/
/
Tenant/employer states to me at the time of sale that the rental of living quarters at this facility constitutes one of the
following:
 Tenant’s primary residence
 Rental is in connection with tenant’s education
 Rental is in connection with tenant’s employment
_________________________________________________________________________________________
Employer or Tenant’s Full Name – (please print)
The tenant or employer has provided documentation, as outlined above, verifying the reason for the exemption from sales
tax. I declare under the penalties of perjury that all statements made by me herein are true, to the best of my knowledge
and belief.
Signature _______________________________________________ Title ____________________________________
(Hotel Employee)
This affidavit is to be retained in the records of the seller to document the qualification of exemption of any rental claimed
exempt under 36 M.R.S. § 1760(20). It must be accompanied by all relevant documentation provided by the purchaser to
demonstrate exemption, valid at the time of the rental of living quarters.
If tax has been paid by the tenant during the initial 28-day period, the tax must be refunded by the retailer. If the retailer
has reported and paid the tax to the State, the retailer should take a corresponding credit on the Sales and Use Tax Return
for the period in which the refund to the tenant was made.
Additional Information
Please refer to Instructional Bulletin No. 32 (“Rental of Living Quarters”) for further details regarding qualifications and
requirements. Instructional Bulletins may be viewed at www.maine.gov/revenue/salesuse/salestax/bulletinssales.htm.
Requests for information on specific situations should be in writing, should contain full information as to the situation in
question and should be directed to:
MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
P.O. BOX 1060
AUGUSTA, MAINE 04332-1060
TEL. NO. (207) 624-9693
Or visit our website at
www.maine.gov/revenue
ST-A-105
11/1/2017
Page of 2