EXEMPTION CERTIFICATE
EXEMPTION CERTIFICATE
TAX ON OCCUPANCY OF HOTEL/MOTEL ROOMS
_ _
DATE
TO BE RETAINED BY OPERATORS OF HOTELS, MOTELS, AND
SIMILAR ACCOMMODATIONS AS EVIDENCE OF EXEMPT OCCUPANCY
__ _ _____________________________________________
(NAME OF HOTEL, APARTMENT HOTEL OR MOTEL)
___ _________________________________________
ADDRESS CITY, STATE
DATES OF
OCCUPANCY ________________
This is to certify that I, the undersigned, am a representative of the United States Governmental department, agency or instrumentality 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 governmental unit:
and that such charges are incurred in the performance of my official duties as a representative or employee of such governmental unit. Accordingly, the charges should be tax exempt.
____________________________
SIGNATURE
FEDERAL
AGENCY ___ Navy Department ___ ____________________________
TITLE
NOTE: (1) A separate exemption certificate is required for each
occupancy and for each representative or employee.
(2) A tax exemption number does not apply to use of this
certificate.
................
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