00 62 76.13
Sales Tax Form
Date
TO:
Vendor Name
Vendor Address
Vendor City State Zip
I hereby certify under penalties of perjury, that:
I am engaged in the performance of a construction contract on a project for the University of Maine
System which is a Sales Tax exempt organization under the Maine Sales and Use Tax Law, Section
1760, subsection 2 and 16;
This Project is titled:
Project Title
This project is located at:
Campus Name or Town
This certificate is issued to cover purchases of materials that will be permanently incorporated into the
real property belonging to the exempt organization or government agency indicated above.
Signed:
Authorized Signature
FIRM
UMS Form ver 1.0 05/2010
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