TAX_EXEMPTION_CERTIFICATE.pdf

TAX EXEMPTION CERTIFICATE

TAX ON OCCUPANCY OF HOTEL ROOMS

IMPOSED PURSUANT TO

ARTICLE 28 AND 29 OF THE TAX LAW

TO BE RETAINED BY OPERATORS OF HOTELS, MOTELS, AND

SIMILAR ACCOMMODATIONS AS EVIDENCE OF EXEMPT

OCCUPANCY.

NAME OF HOTEL/MOTEL ______________________________________

ADDRESS ______________________________________

DATE ______________________________________

This is to certify that I, the undersigned, am a representative of the United States Government, department, and agency or instrumentality indicated below. The charge for the occupancy at the above establishment on the dates set forth below have been or will be paid for by such charges incurred in the performance of my official duties as a representative or employee of such governmental unit.

DATES OF

OCCUPANCY_________________ - __________________

SIGNATURE _____________________

Governmental Unit DOD TAX EXEMPT # 3000500-4

Department of Defense (National Guard Bureau)

Operators of hotels, etc., should not accept this certificate unless the representative presenting it shows satisfactory credentials.

NOTE: A separate exemption is required for each representative or employee.

AGO OREGON FORM 4, dtd 11 FEB 03 OPR: USPFO