HAINES BOROUGH, ALASKA 
                                      P.O. BOX 1209 
                                      HAINES, AK  99827 
                                      (907) 766-6406 * FAX (907) 766-2716 

                APPLICATION FOR SALES TAX EXEMPTION CERTIFICATE 
                                       HAINES BOROUGH 
                
      THE FOLLOWING ORGANIZATION:____________________________________________________, 
       
      A nonprofit corporation, organized under the State of__________________________________________, 
      Hereby applies for a Sales Tax Exemption Certificate in the Haines Borough. As a representative of the 
      organization, I hereby certify that I am familiar with said corporation, that it is organized exclusively for 
      religious, education or charitable purposes, and that the following information is true and correct. 
       
      Local Address of Organization: _________________________________________________________ 
       
      Mailing Address of Organization:________________________________________________________ 
       
      Federal Employer I.D. #________________________________________________________________ 
                             
      Authorized Contact Personnel: __________________________________________________________ 
               (Local Representative) 
       
      **Attach a copy of your letter of 501(c)3, 501(c)4, 501(c)8 or 501(c)19 exemption from the Internal 
      Revenue Service. Please enclose a check or money order for $27.50.** 
       
                            ____________________________________________________ 
                                       SIGNATURE OF REPRESENTATIVE 
       
                            Organization Representative: __________________________(Print Name)                      
                            Title:__________________________________ 
                            Phone Number: _________________________ 
                            Email:_________________________________ 
       
                            MAKE CHECKS PAYABLE TO: HAINES BOROUGH 
      MAIL TO HAINES BOROUGH, ATTN: BUSINESS LICENSING, BOX 1209 HAINES, AK 99827 
       
      FOR OFFICE USE:       AMOUNT PAID:__________                  CHECK:_______________ 
      ACCOUNT #________          DATE PAID:______________                 CASH:________________