Form ST-A-128 "Affidavit of Exemption for Purchases of Pesticide Containers Exempt From the Pesticide Container Fee" - Maine

What Is Form ST-A-128?

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 June 1, 2020;
  • 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-128 by clicking the link below or browse more documents and templates provided by the Maine Department of Administrative and Financial Services.

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Download Form ST-A-128 "Affidavit of Exemption for Purchases of Pesticide Containers Exempt From the Pesticide Container Fee" - Maine

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MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
AFFIDAVIT OF EXEMPTION
For purchases of pesticide containers exempt from the Pesticide Container Fee
NOTE: This affidavit exempts the 15¢ Pesticide Container Fee, imposed by 36 M.R.S. § 4911.
The affidavit does not exempt the sales or use tax from the purchase.
I present this affidavit to _____________________________ and certify, under penalties of
perjury, that the pesticide container(s) purchased from this retailer is/are exempt from the Pesticide
Container Fee pursuant to 36 M.R.S. § 4911(2) as I hold a valid pesticide applicator license, No.
__________________, issued by the Maine Board of Pesticides Control pursuant to 22 M.R.S. §
1471-D.
I further certify that any pesticide containers purchased through this affidavit will be used by me
under the activities approved under my pesticide applicator license.
I further certify that I assume full liability for payment to the State of Maine of any fees, together
with penalties and interest that may later be determined to be due on any purchases covered by this
affidavit because of a taxable use of the property.
______________________________________
____________________________
NAME OF PURCHASER
DATE
______________________________________
____________________________
SIGNATURE
TITLE
NOTICE TO RETAILERS: Retailers making exempt sales covered by this affidavit must appropriately
mark or stamp all invoices to indicate whether they are exempt sales.
Misuse of Affidavit
Purchasers who avoid payment of taxes and fees through deliberate misuse of this affidavit of exemption
may be subject to criminal prosecution.
ST-A-128
6/1/2020
MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
AFFIDAVIT OF EXEMPTION
For purchases of pesticide containers exempt from the Pesticide Container Fee
NOTE: This affidavit exempts the 15¢ Pesticide Container Fee, imposed by 36 M.R.S. § 4911.
The affidavit does not exempt the sales or use tax from the purchase.
I present this affidavit to _____________________________ and certify, under penalties of
perjury, that the pesticide container(s) purchased from this retailer is/are exempt from the Pesticide
Container Fee pursuant to 36 M.R.S. § 4911(2) as I hold a valid pesticide applicator license, No.
__________________, issued by the Maine Board of Pesticides Control pursuant to 22 M.R.S. §
1471-D.
I further certify that any pesticide containers purchased through this affidavit will be used by me
under the activities approved under my pesticide applicator license.
I further certify that I assume full liability for payment to the State of Maine of any fees, together
with penalties and interest that may later be determined to be due on any purchases covered by this
affidavit because of a taxable use of the property.
______________________________________
____________________________
NAME OF PURCHASER
DATE
______________________________________
____________________________
SIGNATURE
TITLE
NOTICE TO RETAILERS: Retailers making exempt sales covered by this affidavit must appropriately
mark or stamp all invoices to indicate whether they are exempt sales.
Misuse of Affidavit
Purchasers who avoid payment of taxes and fees through deliberate misuse of this affidavit of exemption
may be subject to criminal prosecution.
ST-A-128
6/1/2020
GENERAL RESTRICTIONS FOR USE OF THIS AFFIDAVIT OF EXEMPTION
This affidavit is to be retained in the records of the seller to document any sale claimed to be
exempt under 36 M.R.S. § 4911, sub-§2. A copy of this affidavit does not need to be obtained by
the seller on each subsequent purchase. However, if the purchaser indicates that a certain purchase
is believed to be exempt pursuant to this affidavit, the invoice must be appropriately marked to
indicate the exempt sale.
This affidavit must be taken in good faith by the seller. The good faith of the seller will be
questioned if the seller knows, or has reason to know, that the person making the purchase is not
using the products for the intended exempted purpose.
This affidavit is valid only for registered pesticide containers purchased by pesticide applicators
licensed pursuant to 22 M.R.S. §1471-D.
Additional Information
Please see Sales, Fuel & Special Tax Division Instructional Bulletin No. 14 ("Seed, Feed, Fertilizer
and other Items Used in Agricultural and Aquacultural Production") for details regarding sales tax-
exempt pesticides used in commercial agricultural production or commercial aquacultural
production. The bulletin can be found on the MRS website, www.maine.gov/revenue.
Requests for more information on specific situations should be in writing, contain full details 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
Contact Maine Revenue Services with questions by calling (207) 624-9693 weekdays, or by emailing
sales.tax@maine.gov.
ST-A-128
6/1/2020
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