Form ST-104HM Tax Exemption on Lodging Accommodations - pre qualify credit cards for bad credit

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Form ST-104HM
Tax Exemption on Lodging Accommodations
Guest name Lodging provider name (seller)
Address Address
City State ZIP code City State ZIP code
Only employees of the U.S. government, Idaho state government, a local government agency in Idaho, and the
qualified organizations listed in the instructions can claim a tax exemption on lodging or lodging related expenses.
These employees must pay with their organization's qualifying credit card. Employees can't claim the exemption if they
pay the charges with a personal credit card, personal funds, or from expense reimbursements.
Complete the section below that applies to you. To protect credit card information, enter your card number using only
the blank spaces that correspond with the numbers from your card. You must complete this form at the time of sale for
the exemption to apply.
1. U.S. Government
I'm an employee of:
Name of Agency
Choose GSA
SmartPay Method Card Description
Integrated Card: Integrated cards are GOLD and labeled as "U.S. Government Tax Exempt." All charges are billed
directly to the agency and qualify for exemption.
Purchase Card: Purchase cards are RED and labeled as "U.S. Government Tax Exempt." Conference and
meeting room charges qualify for exemption.
Tax Advantage Card: Tax Advantage cards are SILVER and labeled as "U.S. Government CBA Tax Exempt." All
lodging charges are billed directly to the agency and qualify for exemption.
Travel Card: Travel cards are BLUE. The first four digits of the card number are: 4486, 4614, 4615, 5565,
or 5568. Travel cards with the sixth digit of 6, 7, 8, 9, or 0 are billed directly to the government
agency and qualify for exemption. Charges to travel cards with the sixth digit of 1, 2, 3, or 4 don't
qualify for exemption.
Enter credit card number: X X X X X X X
U.S. government employees paying with a credit card other than described above are subject to tax on all lodging and room-related charges.
2. Idaho State Government
(School employees must complete the "Idaho Local Government or Qualified Organization" section below.)
I'm an employee of:
Name of Agency
Qualifying cards are VISA? cards issued by U.S. Bank and are labeled "Tax Exempt." The cards display the name of the
agency and usually the name of the state employee. Lodging charges billed to these cards qualify for exemption. Charges
to other cards, such as Diners Club? that include the state agency and an employee name, are billed directly to the
employee and don't qualify for the exemption.
Enter credit card number: X X X X X X X X
3. Idaho Local Government or Qualified Organization
(See form instructions for a description of local government agencies and qualified organizations.)
Charges to cards that a local government agency or qualified organization pays directly qualify for the exemption. Charges
to cards that the employee is responsible for or must be reimbursed for don't qualify for the exemption.
I'm an employee of:
Name of Agency or Qualified Organization
American Express? Diner's Club? Discover? MasterCard?
Type of card: VISA? Other
Enter credit card number: X X X X X X X X
By signing this form, I certify that the statements I made on this form are true and correct. I know that submitting false
information can result in criminal and civil penalties.
Guest signature Driver's license number and state of issue Work phone number Date
EFO00164 08-16-2022
Form ST-104HM
Tax Exemption on Lodging Accommodations
General. To qualify for the exemption, the ? Run by disabled persons
employee must state the employer's name ? Provide independent living programs to
and indicate the type of credit card used to pay people with various disabilities
for the accommodations. If an employee pays
for the accommodations and is reimbursed by Children's free dental service clinics.
the employer, the charges are subject to all Only nonprofit children's free dental service
applicable taxes. clinics qualify.
GOVERNMENT. Only the U.S. government Credit unions. Both state and federal
and Idaho state, county and city governments credit unions.
qualify. Sales to other states and their political
subdivisions are taxable. Emergency medical service (EMS) agencies.
Lodging accommodations and campground
Only nonprofit emergency medical service
spaces furnished to government employees
agencies qualify.
are exempt from all taxes when the credit card Forest protective associations.
charge is billed directly to and paid directly by
the government agency. Hospitals. Only licensed nonprofit hospitals
Credit cards issued to employees of
qualify. Nursing homes or similar institutions don't.
government agencies are not considered to Idaho Foodbank Warehouse, Inc.
be billed directly to, or paid directly by, the Museums. Only nonprofit museums qualify.
government agency when the employee is A museum collects, preserves, and displays
responsible for paying the credit card company. objects and information to help the public
QUALIFIED ORGANIZATIONS. Lodging interpret the past and present and to explore the
accommodations and campground spaces future. Examples include institutions that exhibit
furnished to qualified organizations are exempt science, history, art, and culture, as well as zoos
from all taxes when the credit card charge and aquariums.
is billed directly to and paid directly by the Qualified health organizations:
qualified organization. See the list below: ? American Cancer Society
Advocates for Survivors of Domestic ? American Diabetes Association
Violence and Sexual Assault, Inc. ? American Heart Association
American Indian tribes. Only tribal entities ? American Lung Association of Idaho
qualify. ? Arc, Inc., The
American Red Cross. ? Arthritis Foundation
Amtrak. ? Camp Rainbow Gold
? Children's Home Society of Idaho
Blind Services Foundation, Inc. ? Easter Seals
Canal companies. Only nonprofit canal ? Family Services Alliance of Southeast Idaho
companies qualify. ? Idaho Association of Free and Charitable
Clinics and its member clinics
Centers for independent living. To qualify, ? Idaho community action agencies
centers must be all of these:
? Nonresidential ? Idaho Cystic Fibrosis Foundation
? Nonprofit
EIN00065 08-16-2022 Page 1 of 2
Form ST-104HM -- Instructions (continued)
? Idaho Diabetes Youth Programs Schools. Certain public or nonprofit schools
? Idaho Epilepsy League qualify. These schools include:
? Idaho Primary Care Association and its ? Colleges and universities
community health centers ? Primary, secondary and charter schools
? Idaho Ronald McDonald House ? Idaho Digital Learning Academy.
? Idaho Women's and Children's Alliance Schools primarily teaching such subjects
? March of Dimes as business, dancing, dramatics, music,
? Mental Health Association cosmetology, writing and gymnastics don't
? Muscular Dystrophy Foundation qualify.
? National Multiple Sclerosis Society Auxiliary organizations such as parent-teacher
? Rocky Mountain Kidney Association associations, booster clubs and alumni groups
? Special Olympics Idaho
don't qualify.
? United Cerebral Palsy Senior citizen centers.
Volunteer fire departments.
For more information visit tax.idaho.gov/lodging
Contact us:
In the Boise area: (208) 334-7660 | Toll free: (800) 972-7660
Hearing impaired (TDD) (800) 377-3529
tax.idaho.gov/contact
EIN00065 08-16-2022 Page 2 of 2


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