EXEMPTION CERTIFICATE
                  TEXAS HOTEL OCCUPANCY STATE TAX
GUEST CERTIFICATION: I declare that I am an occupant of the hotel/motel on offical business sanctioned by the exempt organization named below and that all information shown on this document is true and correct.

Guest Signature:                                                                       Date:
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Guest Name (print)______________________________________________________________

The University of Texas Health Science Center at San Antonio
7703 Floyd Curl Dr., San Antonio, TX 78229-3900
Organizational Exempt Status: Educational
#74-1586031                                                                                                                                                                                                            F-395-040-108
                                                                                                                                                                                                                     Rev. 4/03/cs #475152

For Hotel/Motel Use Only                                                      Date______________________
 

Name of Hotel/Motel

Address of Hotel/Motel

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