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Tax Exemption Certificate
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Tax Exemption Certificate
Tax Exemption Certificate
nico
2019-05-17T11:24:14-04:00
1
Sales and Use Tax Agreement Certificate of Exemption
2
Certificate of Exemption: Multistate Supplemental
This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide this exemption certificate (or data elements required on the form) to a state that would otherwise be due tax on this sale.
The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state, if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-based exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption.
1. Are you attaching the Multistate Supplemental form?
*
Yes
No
If no, select the two-letter postal abbreviation for the state under whose laws you are claiming exemption.
*
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
2. Is this certificate for a single purchase?
*
Yes
No
If yes, enter the related invoice/purchase order #
*
Personal Information
3. Name of purchaser
*
Business Address
*
City
*
State
*
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
*
Purchaser's tax ID number
State of issue
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Country of issue
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
If no tax ID number, enter one of the following:
FEIN
Driver's License Number
Driver's License State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Foreign Diplomat Number
Name of seller from whom you are purchasing, leasing, or renting
*
Seller's address
*
City
*
State
*
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
*
Type of Business
Check the number that descripes your business
4. Type of Business
*
01 Accommodation and food services
02 Agricultural, forestry, fishing, and hunting
03 Construction
04 Finance and insurance
05 Information, publishing, and communications
06 Manufacturing
07 Mining
08 Real estate
09 Rental and leasing
10 Retail trade
11 Transportation and warehousing
12 Utilities
13 Wholesale trade
14 Business services
15 Professional services
16 Education and health-care services
17 Nonprofit organization
18 Government
19 Not a business
20 Other (explain)
You've selected, Type of Business: Other, please specify below.
*
Reason for Exemption
Check the letter that identifies the reason for the expemtion.
5. Reason for Exemption
*
A Federal government (department)
B State or local government (name)
C Tribal government (name)
D Foreign diplomat #
G Resale #
H Agricultural production #
I Industrial production/manufacturing #
J Direct pay permit #
K Direct mail #
L Other (explain)
You've selected, A Federal government (department), please enter the additional information requested for that exemption.
*
You've selected, B State or local government (name), please enter the additional information requested for that exemption.
*
You've selected, C Tribal government (name), please enter the additional information requested for that exemption.
*
You've selected, D Foreign diplomat #, please enter the additional information requested for that exemption.
*
You've selected, G Resale #, please enter the additional information requested for that exemption.
*
You've selected, H Agricultural production #, please enter the additional information requested for that exemption.
*
You've selected, I Industrial production/manufacturing #, please enter the additional information requested for that exemption.
*
You've selected, J Direct pay permit #, please enter the additional information requested for that exemption.
*
You've selected, K Direct mail #, please enter the additional information requested for that exemption.
*
You've selected, L Other, please explain.
*
Sign here
I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.
Signature of authorized purchaser
*
Date
*
Date Format: MM slash DD slash YYYY
Print name here
*
Title
*
Name of purchaser
*
Select your state(s)
*
AR
GA
IA
IN
KS
KY
MI
MN
NC
ND
NE
NJ
NV
OH
OK
RI
SD
TN*
UT
VT
WA
WI
WV
WY
*SSUTA Direct Mail provisions are not in effect for Tennessee.
AR
*
AR
GA
*
GA
IA
*
IA
IN
*
IN
KS
*
KS
KY
*
KY
MI
*
MI
MN
*
MN
NC
*
NC
ND
*
ND
NE
*
NE
NJ
*
NJ
NV
*
NV
OH
*
OH
OK
*
OK
RI
*
RI
SD
*
SD
TN*
*
TN*
UT
*
UT
VT
*
VT
WA
*
WA
WI
*
WI
WV
*
WV
WY
*
WY