Minnesota Application for Sales Tax Exemption for Nursing Homes and Boarding Care Homes

Application for Sales Tax Exemption for Nursing Homes and Boarding Care Homes
Form ST16A, Application for Nonprofit Exempt Status-Sales Tax Nursing Homes and Boarding Care Homes
Form ST16A, Application for Nonprofit Exempt Status—Sales Tax
Nursing Homes and Boarding Care Homes
The Application Process
• We will link your application to your Minnesota Tax ID Number to track the status of your application. If your organization does not have a
Minnesota Tax ID Number, we will assign one to you.
• Allow up to 60 days to receive a determination on your application.
• We may request additional information to determine if your organization qualifies for exempt status.
Organization Name		

Phone		

Mailing Address			

City				

State	

ZIP Code

Main Business Address in Minnesota (If Different From Above)			

City				

State	

ZIP Code

Federal Tax ID Number	

Phone	

Email Address

Minnesota Tax ID Number		

Please Provide:
• A copy of your federal 501(c)(3) letter
• Documentation that you meet one of the following requirements:
This facility is certified to participate in the medical assistance program under Title 19 of the Social Security Act.
This facility does not discharge residents due to the inability to pay. Include a copy of the facility’s discharge policy.
This facility is exempt from property tax. Include a copy of the facility’s most current property tax statement.

Sign Here
I declare this form and supporting documentation is correct and complete to the best of my knowledge and belief and I am authorized to sign on
behalf of the organization.
Signature	

Title		

Date	

Phone

Preparer Signature	

Preparer Minnesota Tax ID Number	

Date	

Preparer Phone

Send Form ST16A, supporting documents, and Form REV184, Power of Attorney (if applicable), to:
Mail:

Minnesota Department of Revenue
Mail Station 6330
600 N. Robert St.
St. Paul, MN 55146-6330

Email:

[email protected]

Rev. 9/19