Maine Media Production Residency Affidavit

Media Production Residency Affidavit
Media Production Affidavit
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Maine Revenue Services
Certified Media Production
Residency Affidavit
36 M.R.S. § 6902(1) allows a certified media production company to receive a reimbursement equal to 12% of certified
production wages paid to employees who are residents of Maine. To assist the production company in qualifying my wage,
I,___________________________________, who resides at ________________________________________________
in the town/city of _________________________________, Maine, hereby certify the following:
1.	 Check if applicable:
I filed as a resident* individual on my most recently filed Maine income tax return; or I was not required to file
an income tax return for the most recently completed tax year, but I could have filed as a resident individual if a
return had been required; or I was claimed, or could have been claimed as a dependent** on a Maine income tax
return of an individual who filed as a resident individual on the filer’s most recently filed Maine income tax return.
2.	 The certified media production company for which this affidavit applies:
A.	 Company’s Name:_________________________________________________________________
B.	 Company’s Address:________________________________________________________________
	

_ _______________________________________________________________________________

C.	 Company’s Employer Identification Number:_ ____________________________________________
3.	 I authorize Maine Revenue Services (“MRS”) to inform the production company above if it is later determined by
MRS that I was not a Maine resident during the certified media production period.
Under penalties of perjury, I declare that I have examined this form and related statements and to the best of my knowledge
and belief they are true, correct and complete.
_____________________________________________________________________________ 	 ___________________
	
Resident’s Signature	
Date
_____________________________________________________________________________ 	
	
Resident’s Printed Name
Resident’s Social Security Number:

-

-

*	 Generally, a Maine resident is an individual (1) who was domiciled in Maine for the entire tax year; or (2) who maintained
a permanent place of abode in Maine for the entire tax year and spent a total of more than 183 days in Maine. For a
more comprehensive description of Maine residency, see the Guidance to Residency Status document at www.maine.
gov/revenue/tax-return-forms (select Income Tax Guidance Documents).
**	 Maine relies on federal rules for determining dependency. Generally, an individual must pay more than 50% of your
support to claim you as a dependent for individual income tax purposes. Other rules apply. For more information, see
federal Form 1040 instructions available at www.irs.gov/forms-instructions.

Note: The media production company must retain a copy of this affidavit on file for at least three years,
available for review by Maine Revenue Services upon request.
Revised: December 2021