Delaware Occupancy Tax - Exemption Certificate

Occupancy Tax - Exemption Certificate
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STATE OF DELAWARE
Division of Revenue
820 N. French Street
Wilmington, Delaware 19801

Note:

FORM 6100
EXEMPTION CERTIFICATE
FROM
TAX ON OCCUPANCY OF
HOTEL, MOTEL & TOURIST HOME ROOMS
CHAPTER 61, TITLE 30, DELAWARE CODE

A Separate Exemption Certificate is Required for Each Occupancy

and for Each Representative or Employee.


PART A - TO BE COMPLETED BY OPERATOR

Name of Hotel, Motel or Tourist Home

Fed. EI or SS Number


Address

Address
City

State

Zip Code

PART B - TO BE COMPLETED BY THE OCCUPANT

This is to certify that I, the undersigned, am a representative of the United States or State

of Delaware Governmental Department or Agency or public school district 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 Government or public school unit; and that such charges are
incurred in the performance of my official duties as a representative or employee of such
Governmental or public school unit.

Name of Individual (Please print or type)

Government Agency

Signature


Title


Address


City

State

Zip Code


Dates of Occupancy


THIS EXEMPTION CERTIFICATE IS TO BE RETAINED BY THE OPERATOR OF THE HOTEL, MOTEL
 

OR TOURIST HOME AS EVIDENCE OF EXEMPT OCCUPANCY FOR A MINIMUM OF FOUR CALENDAR YEARS.