uniform sales & use tax certificate—multijurisdiction certificates for email.pdf · 2013. 4....

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Revised 12/2011 Page 1 of 4 UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on pages 2-4. The issuer and the recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time. Issued to NewWave Technologies, Inc., 4635 Wedgewood Blvd., Ste. 107, Frederick, MD 21703 I certify that: is engaged as a registered Name of Firm (Buyer): ________________________________ Wholesaler Doing Business As: ___________________________________ Retailer Address: ____________________________________________ Manufacturer ___________________________________________________ Seller (California) ___________________________________________________ Lessor (see notes on pages 2-4) ___________________________________________________ Other (Specify)_____________ and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product or service 1 to be resold, leased, or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following: Description of Business: ___________________________________________________________________________________________________________ General description of tangible property or taxable services to be purchased from the seller:______________________________________________________ _______________________________________________________________________________________________________________________________ State State Registration, Seller’s Permit, or ID Number of Purchaser State State Registration, Seller’s Permit, or ID Number of Purchaser AL 1 _____________________________ MO 16 ______________________________ AR _____________________________ NE 17 ______________________________ AZ 2 _____________________________ NV ______________________________ CA 3 _____________________________ NJ ______________________________ CO 4 _____________________________ NM 4,18 ______________________________ CT 5 _____________________________ NC 19 ______________________________ DC 6 _____________________________ ND ______________________________ GA 8 _____________________________ OH 20 ______________________________ HI 4,9 _____________________________ OK 21 ______________________________ ID _____________________________ PA 22 ______________________________ IL 4,10 _____________________________ RI 23 ______________________________ IA _____________________________ SC ______________________________ KS _____________________________ SD 24 ______________________________ KY 11 _____________________________ TN ______________________________ ME 12 _____________________________ TX 25 ______________________________ MD 13 _____________________________ UT ______________________________ MI 14 _____________________________ VT ______________________________ MN 15 _____________________________ WA 26 ______________________________ WI 27 ______________________________ I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature: _________________________________________________________________________ (Owner, Partner or Corporate Officer) Title: ______________________________________________________________________________________ Phone: ______________________________Date: ______________________________________________________________________________________ Additional NewWave notes: The following states do not accept this Uniform Sales & Use Tax Certificate-Multijurisdiction, but require the following documents: FL: unexpired DR-13; IN: ST-105; LA: R-1055 or L-1064; MA: ST-4; MS: MS Sales Tax Permit; NY: ST-120; VA: ST-10; WV: SSTGB Form F0003(Streamlined...); WY: SSTGB Form F0003(Streamlined...). If your home state is one of the previously listed states, please be sure to complete this Uniform Sales & Use Tax Certificate – Multijurisdiction form as well, so that NWT can exempt tax for the states that honor home state certificates. The following states do not charge sales tax: AK, DE, MT, NH, OR.

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Page 1: UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION Certificates for Email.pdf · 2013. 4. 1. · Revised 12/2011 Page 3 of 4 10. Use of this certificate in Illinois is subject

Revised 12/2011

Page 1 of 4

UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on pages 2-4. The issuer and the recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time. Issued to NewWave Technologies, Inc., 4635 Wedgewood Blvd., Ste. 107, Frederick, MD 21703 I certify that: is engaged as a registered Name of Firm (Buyer): ________________________________ Wholesaler Doing Business As: ___________________________________ Retailer Address:____________________________________________ Manufacturer ___________________________________________________ Seller (California) ___________________________________________________ Lessor (see notes on pages 2-4) ___________________________________________________ Other (Specify)_____________ and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product or service1 to be resold, leased, or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following: Description of Business: ___________________________________________________________________________________________________________ General description of tangible property or taxable services to be purchased from the seller:______________________________________________________ _______________________________________________________________________________________________________________________________

State State Registration, Seller’s Permit, or ID Number of Purchaser

State State Registration, Seller’s Permit, or ID Number of Purchaser

AL1 _____________________________ MO16 ______________________________ AR _____________________________ NE17 ______________________________ AZ2 _____________________________ NV ______________________________ CA3 _____________________________ NJ ______________________________ CO4 _____________________________ NM4,18 ______________________________ CT5 _____________________________ NC19 ______________________________ DC6 _____________________________ ND ______________________________ GA8 _____________________________ OH20 ______________________________ HI4,9 _____________________________ OK21 ______________________________ ID _____________________________ PA22 ______________________________ IL4,10 _____________________________ RI23 ______________________________ IA _____________________________ SC ______________________________ KS _____________________________ SD24 ______________________________ KY11 _____________________________ TN ______________________________ ME12 _____________________________ TX25 ______________________________ MD13 _____________________________ UT ______________________________ MI14 _____________________________ VT ______________________________ MN15 _____________________________ WA26 ______________________________ WI27 ______________________________

I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or use Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature: _________________________________________________________________________ (Owner, Partner or Corporate Officer) Title: ______________________________________________________________________________________ Phone: ______________________________Date: ______________________________________________________________________________________ Additional NewWave notes: The following states do not accept this Uniform Sales & Use Tax Certificate-Multijurisdiction, but require the following documents: FL: unexpired DR-13; IN: ST-105; LA: R-1055 or L-1064; MA: ST-4; MS: MS Sales Tax Permit; NY: ST-120; VA: ST-10; WV: SSTGB Form F0003(Streamlined...); WY: SSTGB Form F0003(Streamlined...). If your home state is one of the previously listed states, please be sure to complete this Uniform Sales & Use Tax Certificate – Multijurisdiction form as well, so that NWT can exempt tax for the states that honor home state certificates. The following states do not charge sales tax: AK, DE, MT, NH, OR.

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Page 2: UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION Certificates for Email.pdf · 2013. 4. 1. · Revised 12/2011 Page 3 of 4 10. Use of this certificate in Illinois is subject

Revised 12/2011

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INSTRUCTIONS REGARDING UNIFORM SALES & USE TAX CERTIFICATE To Seller’s Customers: In order to comply with the majority of state and local sales tax law requirements, the seller must have in its files a properly executed exemption certificate from all of its customers who claim a sales tax exemption. If the seller does not have this certificate, it is obliged to collect the tax for the state in which the property or service is delivered. If the buyer is entitled to sales tax exemption, the buyer should complete the certificate and send it to the seller at its earliest convenience. If the buyer purchases tax free for a reason for which this form does not provide, the buyer should send the seller its special certificate or statement. Caution to Seller: In order for the certificate to be accepted in good faith by the seller, seller must exercise care that the property or service being sold is of a type normally sold wholesale, resold, leased, rented or incorporated as a ingredient or component part of a product manufactured by buyer and then resold in the usual course of its business. A seller failing to exercise due care could be held liable for the sales tax due in some states or cities. Misuse of this certificate by seller, lessee, or the representative thereof may be punishable by fine, imprisonment or loss of right to issue certificate in some states or cities. _______________________________ Notes:

1. Alabama: Each retailer shall be responsible for determining the validity of a purchaser’s claim for exemption. 2. Arizona: This certificate may be used only when making purchases of tangible personal property for resale in the ordinary course of

business, and not for any other statutory deduction or exemption. It is valid as a resale certificate only if it contains the purchaser’s name, address, signature, and Arizona transaction privilege tax (or other state sales tax) license number, as required by Arizona Revised Statutes § 42-5022, Burden of proving sales not at retail.

3. California: A. This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to the

provisions of Title 18, California Code of Regulations, Section 1668 (Sales and Use Tax Regulation 1668, Resale Certificate).

B. By use of this certificate, the purchaser certifies that the property is purchased for resale in the regular course of business in the form of tangible personal property, which includes property incorporated as an ingredient or component part of an item manufactured for resale in the regular course of business.

C. When the applicable tax would be sales tax, it is the seller who owes that tax unless the seller takes a timely and valid resale certificate in good faith.

D. A valid resale certificate is effective until the issuer revokes the certificate. 4. The state of Colorado, Hawaii, Illinois, and New Mexico do not permit the use of this certificate to claim a resale exemption for the

purchase of a taxable service for resale. 5 Connecticut: This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to Conn.

Gen. State §§12-410(5) and 12-411(14) and an regulations and administrative pronouncements pertaining to resale certificates. 6. District of Columbia: This certificate is not valid as an exemption certificate. It is not valid as a resale certificate unless it contains the

purchaser’s D.C. sales and use tax registration number. 7. Florida: The Department will allow purchasers to use the Multistate Tax Commission’s Uniform Sales and Use Tax Certificate-

Multijurisdiction. However, the use of this uniform certificate must be used in conjunction with the telephonic or electronic authorization number method described in paragraph (3)(b) or (c) of rule SUT FAC 12A-1.039..

8. Georgia: the purchaser’s state of registration number will be accepted in lieu of Georgia’s registration number when the purchaser is

located outside Georgia, does not have nexus with Georgia, and the tangible personal property is delivered by drop shipment to the purchaser’s customer located in Georgia.

9. Hawaii allows this certificate to be used by the seller to claim a lower general excise tax rate or no general excise tax, rather than the

buyer claiming an exemption. The no tax situation occurs when the purchaser of imported goods certifies to the seller, who originally imported the goods into Hawaii, that the purchaser will resell the imported goods at wholesale. If the lower rate or no tax does not in fact apply to the sale, the purchaser is liable to pay the seller the additional tax imposed. See Hawaii Dept. of Taxation Tax Information Release No. 93-5, November 10, 1993, and Tax Information Release No. 98-8, October 30, 1998.

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10. Use of this certificate in Illinois is subject to the provisions of 86 Ill. Adm. Code Ch.I, Sec. 130.1405. Illinois does not have an

exemption on sales of property for subsequent ease or rental, nor does the use of this certificate for claiming resale purchases of services have any application in Illinois.

The registration number to be supplied next to Illinois on page 1 of this certificate must be the Illinois registration or resale number;

no other state’s registration number is acceptable. “Good faith” is not the standard of care to be exercised by a retailer in Illinois. A retailer in Illinois is not required to determine if the

purchaser actually intends to resell the item. Instead, a retailer must confirm that the purchaser has a valid registration or resale number at the time of purchase. If a purchaser fails to provide a certificate of resale at the time of sale in Illinois, the seller must charge the purchaser tax.

While there is no statutory requirement that blanket certificates of resale be renewed at certain intervals, blanket certificates should be

updated periodically, and no less frequently than every three years. 11. Kentucky: 1. Kentucky does not permit the use of this certificate to claim a resale exclusion for the purchase of a taxable service. 2. This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to the

provisions of Kentucky Revised Statute 139.270 (Good Faith). 3. The use of this certificate by the purchaser constitutes the issuance of a blanket certificate in accordance with Kentucky

Administrative Regulation 103 KAR 31:111. 12. Maine does not have an exemption on sales of property for subsequent lease or rental. 13. Maryland: This certificate is not valid as an exemption certificate. However, vendors may accept resale certificates that bear the

exemption number issued to a religious organization. Exemption certifications issued to religious organizations consist of 8 digits, the first two of which are always “29”. Maryland registration, exemption and direct pay numbers may be verified on the website of the Comptroller of the Treasury at www.marylandtaxes.com.

14 Michigan: Effective for a period of four years unless a lesser period is mutually agreed to and stated on this certificate. Covers all

exempt transfers when accepted by the seller in “good faith” as defined by Michigan statute. 15. Minnesota: A. Does not allow a resale certificate for purchases of taxable services for resale in most situations. B. Allows an exemption for items used only once during production and not used again. 16. Missouri: A. Purchases who improperly purchase property or services sales tax free using this certificate may be required to

pay the tax, interest, additions to tax or penalty. B. Even if property is delivered outside Missouri, facts and circumstances may subject it to Missouri tax, contrary

to the second sentence of the first paragraph of the above instructions. 17. Nebraska: A blanket certificate is valid 3 years from the date of issuance. 18. New Mexico: For transactions occurring on or after July 1, 1998, New Mexico will accept this certificate in lieu of a New Mexico

nontaxable transaction certificate and as evidence of the deductibility of a sale tangible personal property provided: a) this certificate was not issued by the State of New Mexico; b) the buyer is not required to be registered in New Mexico; and c) the buyer is purchasing tangible personal property for resale or incorporations as an ingredient or component part into a

manufactured product. 19. North Carolina: This certificate is not valid as an exemption certificate or if signed by a person such as a contractor who intends to

use the property. Its use is subject to G.S. 105-164.28 and any administrative rules or directives pertaining to resale certificates.

20. Ohio: A. The buyer must specify which one of the reasons for exemption on the certificate applies. This may be done by

circling or underlining the appropriate reason or writing it on the form above the state registration section. Failure to specify the exemption reason will, on audit, result in disallowance of the certificate.

B. In order to be valid, the buyer must sign and deliver the certificate to the seller before or during the period for filing

the return.

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21. Oklahoma would allow this certificate in lieu of a copy of the purchaser’s sales tax permit as one of the elements of “properly completed documents” which is one of the three requirements which must be met prior to the vendor being relieved of liability. The other two requirements are that the vendor must have the certificate in his possession at the time the sale is made and must accept the documentation in good faith. The specific documentation required under OAC 710-:65-7-6 is:

A) Sales tax permit information may consist of: (i) A copy of the purchaser’s sales tax permit; or (ii) In lieu of a copy of the permit, obtain the following: (I) Sales tax permit number; and (II) The name and address of the purchaser; B) A statement that the purchaser is engaged in the business of reselling the articles purchased; C) A statement that the articles purchased are purchased for resale; D) The signature of the purchaser or a person authorized to legally bind the purchaser; and E) Certification on the face of the invoice, bill or sales slip or on separate letter that said purchaser is engaged in reselling the

articles purchased. Absent strict compliance with these requirements, Oklahoma holds a seller liable for sales tax due on sales where the claimed

exemption is found to be invalid, for whatever reason, unless the Tax Commission determines that purchaser should be pursued for collection of the tax resulting from improper presentation of a certificate.

22. Pennsylvania: This certificate is not valid as an exemption certificate. It is valid as a resale certificate only if it contains the

purchaser’s Pennsylvania Sales and Use Tax eight-digit license number, subject to the provisions of 61 PA Code §32.3.

23. Rhode Island allows this certificate to be used to claim a resale exemption only when the item will be resold in the same form. They

do not permit this certificate to be used to claim any other type of exemption. 24. South Dakota: Services which are purchased by a service provider and delivered to a current customer in conjunction with the

services contracted to be provided to the customer are claimed to be for resale. Receipts from the sale of a service for resale by the purchaser are not subject to sales tax if the purchaser furnishes a resale certificate which the seller accepts in good faith. In order for the transaction to be a sale for resale, the following conditions must be present:

(1) The service is purchased for or on behalf of a current customer; (2) The purchaser of the service does not use the service in any manner; and (3) The service is delivered or resold to the customer without any alteration or change. 25. Texas: Items purchased for resale must be for resale within the geographical limits of the United States, its territories and possessions. 26. Washington: A. Blanket resale certificates must be renewed at intervals not to exceed four years; B. This certificate may be used to document exempt sales of “chemicals to be used in processing an article to be

produced for sale.” C. Buyer acknowledges that the misuse of the tax due, in addition to the tax, interest, and any other penalties imposed

by law. 27. Wisconsin allows this certificate to be used to claim a resale exemption only. It does not permit this certificate to be used to claim any

other type of exemption.

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F0008 7/23/07

Streamlined Sales and Use Tax Agreement

Certificate of Exemption Instructions Use this form to claim exemption from sales tax on purchases of otherwise taxable items. The purchaser must complete all fields on the exemption certificate and provide the fully completed certificate to the seller in order to claim exemption.

Warning to purchaser: You are responsible for ensuring that you are eligible for the exemption you are claiming. You will be held liable for any tax and interest, and possibly penalties imposed by the member state due the tax on your purchase, if the purchase is not legally exempt.

Purchaser instructions for completing the exemption certificate

1. Some purchasers may wish to complete a single certificate for multiple states where they conduct business and, regularly, make exempt purchases from the same seller. If you do, check the box on the front of the SSUTA Certificate of Exemption to indicate that you are attaching the Multistate Supplemental form.

CAUTION: Certificates completed with a multistate supplement may include non-member states of the SST Governing Board, provided those states have agreed to accept the SSUTA Certificate of Exemption. Both sellers and purchasers MUST BE AWARE that these additional non-member states may not have adopted the SSUTA provisions for Multiple Points of Use and Direct Mail. Additionally, completion of this certificate in its entirety may not fully relieve the seller from liability unless non-member states’ requirements have been met.

If you are not attaching the Multistate Supplemental form, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption. For example, if you are claiming an exemption from sales or use tax imposed by the state of Minnesota, enter “MN” in the boxes provided. If you are claiming exemption for more than one member state, complete the SSUTA Certificate of Exemption: Multistate Supplemental form.

2. Single purchase exemption certificate: Check this box if this exemption certificate is being used for a single purchase. Include the invoice or purchase order number for the transaction.

If this box is not checked, this certificate will be treated as a blanket certificate. A blanket certificate continues in force so long as the purchaser is making recurring purchases (at least one purchase within a period of twelve consecutive months) or until otherwise cancelled by the purchaser.

3. Purchaser information: Complete the purchaser and seller information section, as requested. An identification number for you or your business must be included. Include your state tax identification number and identify the state and/or country that issued the number to you. If you do not have a state tax identification number, enter the Federal Employers Identification Number (FEIN) issued to your business, or if no FEIN number is required, enter your personal driver’s license number and the state in which it is issued. Foreign diplomats and consular personnel must enter the individual tax identification number shown on the sales tax exemption card issued to you by the United States Department of State’s Office of Foreign Missions.

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F0008 7/23/07

Multistate Purchasers: The purchaser should enter its headquarters address as its business address.

4. Type of business: Circle the number that best describes your business or organization. If none of the categories apply, circle number 20 and provide a brief description.

5. Reason for exemption: Circle the exemption that applies to you or your business and enter the additional information requested for that exemption. If the member state that is due tax on your purchase does not require the additional information requested for the exemption reason code circled, enter “NA” for not applicable on the appropriate line. If an exemption that is not listed applies, circle “M Other” and enter an explanation. The explanation for “M Other” must include a clear and concise explanation of the reason for the exemption claimed. Some more common exemptions that may be listed as explanation could be: interstate carrier for hire, qualified air pollution equipment, enterprise zone, etc.

Multistate Purchasers: Attach the SSUTA Certificate of Exemption – Multistate Supplemental Form and indicate the applicable reason for exemption and identification number (if required) for each of the additional states in which the purchaser wishes to claim exemption from tax.

CAUTION: The exemptions listed are general exemptions most commonly allowed by member states. However, each state’s laws governing exemptions are different. Not all of the reasons listed may be valid exemptions in the state in which you are claiming exemption. In addition, each state has other exemptions that may not be listed on this form. To determine what sales and use tax exemptions are allowed in a particular state refer to the state’s web site or other information available relating to that state’s exemptions.

Seller: You are required to maintain proper records of exempt transactions and provide those records to Member states of the SST Governing Board, Inc., when requested. These certificates may be provided in paper or electronic format. If a paper exemption certificate is not forwarded by the purchaser, but instead the data elements required on the form are otherwise captured by the seller, the seller must maintain such data and make it available to Member states in the form in which it is maintained by the seller.

You are relieved of the responsibility for collecting and remitting sales tax on the sale or sales for which the purchaser provided you with this exemption certificate, even if it is ultimately determined that the purchaser improperly claimed an exemption, provided all of the following conditions are met:

1. All fields on the exemption certificate are completed by the purchaser or the required information is captured and maintained. (The reason code ID # in Section 5 is not required for the exemption certificate to be fully completed.);

2. The fully completed exemption certificate (or the required information) is provided to you at the time of sale or as otherwise provided by Section 317 of the SSUTA;

3. If the purchaser is claiming an entity-based exemption (i.e., an exemption based on who the purchaser is, such as a charitable organization), the state that would otherwise be due the tax on the sale allows the specific entity-based exemption claimed by the purchaser if the purchase was made at a sale location operated by the seller within that state;

4. If a business purchaser claims a multiple points of use exemption reason code (note that effective dates for this exemption may vary by state) as provided under Section 312 of the SSUTA, and the items being purchased are not tangible personal property other than computer software;

5. You do not fraudulently fail to collect the tax due; or

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6. You do not solicit customers to unlawfully claim an exemption.

Page 8: UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION Certificates for Email.pdf · 2013. 4. 1. · Revised 12/2011 Page 3 of 4 10. Use of this certificate in Illinois is subject

Streamlined Sales and Use Tax Agreement Certificate of Exemption 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 the 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. Check if you are attaching the Multi-state Supplemental form. If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption. 2. Check if this certificate is for a single purchase and enter the related invoice/purchase order #________________________________. 3. Please print___________________________________________________________________________________________

Name of purchaser __________________________________________________________________________________________________________________ Business Address City State Zip Code Purchaser’s Tax ID Number State of Issue Country of Issue __________________________________________________________________________________________________________________ If no Tax ID Number | FEIN | Driver’s License Number/State Issued ID Number | Foreign diplomat number Enter one of the following: | | | ______________________|__________________ |_State of Issue: Number____________________________|_____________________ Name of seller from whom you are purchasing, leasing or renting _________________________________________________________________________________________ Seller’s address City State Zip code _________________________________________________________________________________________

4. Type of business. Circle the number that describes your business

01 Accommodation and food services 11 Transportation and warehousing 02 Agricultural, forestry, fishing, hunting 12 Utilities 03 Construction 13 Wholesale trade 04 Finance and insurance 14 Business services 05 Information, publishing and communications 15 Professional services 06 Manufacturing 16 Education and health-care services 07 Mining 17 Nonprofit organization 08 Real estate 18 Government 09 Rental and leasing 19 Not a business 10 Retail trade 20 Other (explain)__________________________

5. Reason for exemption. Circle the letter that identifies the reason for the exemption.

A Federal government (department)_________________ H Agricultural production #_____________________ B State or local government (name)_________________ I Industrial production/manufacturing #___________ C Tribal government (name)_______________________ J Direct pay permit #__________________________ D Foreign diplomat # ____________________________ K Direct mail #_______________________________ E Charitable organization #________________________ L Other (explain)______________________________ F Religious or educational organization #_____________ G Resale #_____________________________________

6. 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 Print Name Here Title Date __________________________________________________________________________________________________________________ SSTGB Form F0003 Exemption Certificate (5/10/11)

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Streamlined Sales and Use Tax Agreement Certificate of Exemption Multi-state Supplemental Name of Purchaser

STATE Reason for Exemption Identification Number (If Required) 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. The following nonmember states will accept this certificate for exemption claims that are valid in their respective state. SSUTA Direct Mail provisions do not apply in these states.

XX XX XX XX XX XX XX XX XX XX XX XX XX XX

Page 10: UNIFORM SALES & USE TAX CERTIFICATE—MULTIJURISDICTION Certificates for Email.pdf · 2013. 4. 1. · Revised 12/2011 Page 3 of 4 10. Use of this certificate in Illinois is subject

Form ST-105State Form :19065 R'+/ 8-0-5

Indiana Department of Revenue

General Sales Thx Exemption Certificate

Indiana registered relail merchants and businesses located outside Indiana may use this certificate. The claimed exemption must be allowed by Indiana

code. Exemption slatutes of other states are not valid tbr purchases from Indiana vendors. This exemption certilicate can not be issued for the

purchase of lLili/iqg, Vehicles, Watercraft, or Ai/crafr. Pttrcha.ser must be registered with the Depafiment of Revenue or the appropriate taxing

authority ofthe purchaser's state of residence.

Sales tax must be charged unless a!! information in each 6ection is fully completed by the purchaser. Purchasers not able to provide all required

information must pay the tax and may file a ctaim for refund (Form GA- I lol-) directly with the Department of Revenue.

H

Name of Purchaser

Business Address City State _ Zip

Purchaser must provide minimum of one ID nuniber belc lw. t '

Provide your Indiana Registered Retail Merchant's Certif icatc

TID and LOC Number as shown on your Certif icate.

If not registered with the Indiana DOR, provide your State Tax

ID Number f rom another State. . . . . .

T ID# ( l 0 d ig i t s ) LOC# ( 3 digits)

*See instructions on the reverse side if vou do not have either number. Srare lD# State of Issue

Is th is a I b lanket purchase exempt ion request or a I s ingle purchase exempt ion request? (check one)

Descr ipt ion of i lems to be purchased.

Purchaser must indicate the lype oI exemption being claimed for this purchase. (check one or explain)

E Sales to a retailer, wholesaler, or manufacturer for resale only.

E Sale of manufactu ng machinery tools. and equipment to be used directly in direct production.

E Sales to nonprofft organizations claiming exemption pursuant to Sales Tax lnformation Bullelin #10.(May not be used for personal hotel rooms and meals.)

E Sales ofrangible personal property predominately used (greaterthen 50 percent) in providing public transportation - provide USDOT#.A person or corporalion who is bauling under someone else's motor carrier authority, or has a contract as a school bus operator, mustprovidc their SS# or FID# in lieu of a State ID# in Section #1. USDOT# -

E Sales to persons, occupationally engaged as famers, to be used directly in production of agricultural products for sale.Note: A farmer not possessing a State Business License# may enter a FID# or a SS# in lieu of a State ID# in Section #1.

E Sales to a contractor for exempt projects (such as public $chools, Sovemment, or nonprofits).

E Sales to Indiana Governmental Units (agencies, cilies, towns. municipalities, public schools, and slate universities).

El Sales to the United States Federal Government - show agency name.

Note: A U.S. Government asencv should enter its Federal Identification Number (FID#) in Section #1 in l ieu of a State ID#.

E Other - expla in.

I hereby cerlify under the penalties of perjury that lhe propeny purchased by the use of this exemption certificate is to be used for an exemptpurpose pursuanl to the State Cross Retail Sales Tax Act, Indiana Code 6-2.5, and the item purchased is not a utility, vehicle, watercraft, or aircraft.

I confirm my undeBtanding that misuse, (?ifrer egligent or intentioral), and/or fraudulent use ofthis certificate may subject both me personally

and/or the business entity I represenl to the imposition oftax, interest, and civil and/or criminal penalties.

Signature of Purchaser Date

TitlePrinted Name

The Indiana Dcpartntent of Revenue may request verification of registration in another state if you are an out-of-state purchaser.

Seller must keep this certificate on file to support exempt sales.

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For.mST-105General Infonnation and Instructions

All four (4) sections of the ST- I 05 must be completed or the exemption is not valid and the seller is responsiblefor the collection of the Indiana sales tax.

A) This section requires an identification number. In most cases this number will be an IndianaDeparunent ofRevenue issued Taxpayer ldentification Number (TID# - see note below) used forIndiana sales and/or withholding tax reporting. If the purchaser is from another state and doei notpossess an Indiana TID#, a resident state's business license, or State issued ID# must be provided.

B) Exceptions - For a purchaser not possessing either an Indiana TID# or another State ID#, the followingmay be used in lieu of this requirement.tr'ederal Government - place your FID# in the State ID# space.Farmer - place your SS# or FID# in the State ID# space.Public transportation haulers operating under another motor carrier authority, or witb a contract as aschool bus operator, must indicate their SS# or FID# in the State ID# space.Nonprolit Organization - must show its FID# in the State ID# space.

A) Check a box to indicate if this is a single purchase or blanket exemption.B) Describe product being purchased.

A) Purchaser must check the reason for exemption.B) Purchaser must be able to provide additional information if requested.

A) Purchaser must sign and date the form.B) Printed name and title of signer must be shown.

Note: The Indiana Tlrxpayer Identification Number (TID#) is a ten (10) digit number followed by a thtee (3)

digit LOC#. The TID# is also known as the following:a) Registered Retail Merchant Certificat€b) Tax Exempt Identification Numberc) Sales Tax Identification Numberd) Withholding Tax Identification Number

The Registered Retail Merchant Certificate issued by the Indiana Departrnent ofRevenue showsthe TID# ( I 0 digits) and the LOC# (3 digits) at the top right of the certificate'

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Use this link to access your Louisiana resale certificate, R-1064 or R-1065. You may have to create an account to do so. Online Resale Certificates Or copy and paste this into your web browser: https://esweb.revenue.louisiana.gov/OnlineResaleCertificates/Login.aspx?ReturnUrl=%2fOnlineResaleCertificates%2fdefault.aspx

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Form ST-4Sales Tax Resale Certificate

Name of purchaser Social Security or Federal Identification number

Address

City/Town State Zip

Type of business in which purchaser is engaged:

Type of tangible personal property or service being purchased (be as specific as possible):

Name of vendor from whom tangible personal property or services are being purchased:

Address City/Town State Zip

I hereby certify that I hold a valid Massachusetts Vendor’s Registration, issued by the Commissioner of Revenue, pursuant to Massachusetts GeneralLaws, Chapter 64H, section 7, and that I am in the business of selling the kind of tangible personal property or services being purchased under thiscertificate, and that I intend to sell such property or services in the regular course of my business.

Signed under the penalties of perjury.

Signature of purchaser Title Date

Check applicable box: Single purchase certificate Blanket certificate

Rev. 3/05

MassachusettsDepartment ofRevenue

Notice to Vendors1. Massachusetts General Laws assume that all gross receipts ofa vendor from the sale of tangible personal property and servicesare from sales subject to tax, unless the contrary is established. Theburden of proving that a sale of tangible personal property or serviceby any vendor is not a retail sale is placed upon the vendor unlesshe/she accepts from the purchaser a certificate declaring that theproperty or service is purchased for resale.

2. A resale certificate relieves the vendor from the burden of proofonly if it is taken in good faith from a purchaser who is engaged inthe business of selling tangible property or services and who holdsa valid Massachusetts sales tax registration.

3. The good faith of the vendor will be questioned if he/she hasknowledge of facts which give rise to a reasonable inference that thepurchaser does not intend to resell the property or services. For ex-ample, knowledge that a purchaser of particular merchandise is notengaged in the business of selling the kind of merchandise or servicehe/she is purchasing under this certificate would constitute groundsto question the good faith of the vendor.

4. The vendor must make sure that the certificate is filled out prop-erly and signed before accepting it.

5. The vendor must retain this certificate as part of his/her perma-nent tax records.

If you have any questions about the acceptance or use of this cer-tificate, please contact: Massachusetts Department of Revenue,Customer Service Bureau, PO Box 7010, Boston, MA 02204, orcall (617) 887-MDOR or toll-free, in-state 1-800-392-6089.

Notice to Purchasers1. This certificate is to be used when the purchaser intends to resellthe tangible personal property or service in the regular course ofbusiness. Manufacturers claiming an exempt use of the materials,tools and fuel which will be used in the manufacture, processing orconversion of tangible personal property should use Form ST-12,Exempt Use Certificate. Tax-exempt organizations making pur-chases for other than resale are to use Form ST-5, Exempt Pur-chaser Certificate.

2. The purchaser must hold a valid Massachusetts vendor regis-tration. If you need to apply for a registration, go to www.mass.gov/dorand click on WebFile for Business to complete an online applicationfor registration.

3. This certificate must be signed by and bear the name and ad-dress of the purchaser and his/her Federal Identification number.This certificate must also indicate the type of tangible personalproperty purchased and resold by the purchaser.

4. If a purchaser who gives a certificate makes any use of the prop-erty other than retention, demonstration or display while holding it forsale in the regular course of business, such property will be subjectto the Massachusetts sales or use tax, as of the time the property isfirst used by him/her.

5. If you are engaged in a service activity, and are unsure as to theeligibility of the tangible personal property being purchased for re-sale, see the regulation on Service Enterprises, 830 CMR 64H.1.1.

6. For further information about the use of resale certificates,see the regulation on Resale and Exempt Use Certificates, 830CMR 64H.8.1.

Warning: Willful misuse of this certificate may result in criminaltax evasion sanctions of up to one year in prison and $10,000($50,000 for corporations) in fines.

This form is approved by the Commissioner of Revenue and may be reproduced.

40M 2/02 CRP0102 printed on recycled paper

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New York State Department of Taxation and Finance

New York State and Local Sales and Use Tax

Resale Certificate

Mark an X in the appropriate box: Single-use certificate Blanket certificateTemporary vendors must issue a single-use certificate.

ST-120 (1/11)

Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evade any such tax may constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentence. I understand that this document is required to be filed with, and delivered to, the vendor as agent for the Tax Department for the purposes of Tax Law section 1838 and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. I also understand that the Tax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document.

Name of seller Name of purchaser

Street address Street address

City State ZIP code City State ZIP code

Purchaser information – please type or printI am engaged in the business of and principally sell

(Contractors may not use this certificate to purchase materials and supplies.)

Part 1 – To be completed by registered New York State sales tax vendorsI certify that I am:

a New York State vendor (including a hotel operator or a dues or admissions recipient), show vendor or entertainment vendor. My valid Certificate of Authority number is a New York State temporary vendor. My valid Certificate of Authority number is and expires on

I am purchasing:

A. Tangible personal property (other than motor fuel or diesel motor fuel) • for resale in its present form or for resale as a physical component part of tangible personal property; • for use in performing taxable services where the property will become a physical component part of the property upon which the

services will be performed, or the property will actually be transferred to the purchaser of the taxable service in conjunction with the performance of the service; or

B. A service for resale, including the servicing of tangible personal property held for sale.

Part 2 – To be completed by non-New York State purchasers

I certify that I am not registered nor am I required to be registered as a New York State sales tax vendor. I am registered to collect salestax or value added tax (VAT) in the following state/jurisdiction and havebeen issued the following registration number (If sales tax or VAT registration is notrequired and a registration number is not issued by your home jurisdiction, indicate the location of your business and write not applicable on the line requesting the registration number.)

I am purchasing:

C. Tangible personal property (other than motor fuel or diesel motor fuel) for resale, and it is being delivered directly by the seller to my customer or to an unaffiliated fulfillment services provider in New York State.

D. Tangible personal property for resale that will be resold from a business located outside New York State.

Type or print name and title of owner, partner, or authorized person of purchaser

Signature of owner, partner, or authorized person of purchaser Date prepared

Substantial penalties will result from misuse of this certificate.

To the purchaser:You may not use this certificate to purchase items or services that are not for resale. If you purchase tangible personal property or services for resale, but use or consume the tangible personal property or services yourself in New York State, you must report and pay the unpaid tax directly to New York State. Any misuse of this certificate will result in tax liabilities and substantial penalty and interest.

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Need help?

Sales Tax Information Center: (518) 485-2889

To order forms and publications: (518) 457-5431 Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): (518) 485-5082

Internet access: www.tax.ny.gov (for information, forms, and publications)

Form ST-120, Resale Certificate, is a sales tax exemption certificate. This certificate is only for use by a purchaser who:A – is registered as a New York State sales tax vendor and has a

valid Certificate of Authority issued by the Tax Department and is making purchases of tangible personal property (other than motor fuel or diesel motor fuel) or services that will be resold or transferred to the purchaser’s customers, or

B – is not required to be registered with the New York State Tax Department;

– is registered with another state, the District of Columbia, a province of Canada, or other country, or is located in a state, province, or country which does not require sellers to register for sales tax or VAT purposes; and

– is purchasing items for resale that will be either: 1) delivered by the seller to the purchaser’s customer or to an

unaffiliated fulfillment service provider located in New York State, or

2) delivered to the purchaser in New York State, but resold from a business located outside the state.

Note: For purposes of 1) above, delivery by the seller includes delivery in the seller’s own vehicle or by common carrier, regardless of who arranges for the transportation.

Non-New York State purchasers: registration requirementsIf, among other things, a purchaser has any place of business or salespeople in New York State, or owns or leases tangible personal property in the State, the purchaser is required to be registered for New York State sales tax.

A business must register (unless the business can rebut the statutory presumption as described in TSB-M-08(3.1)S, Additional Information on How Sellers May Rebut the New Presumption Applicable to the Definition of Sales Tax Vendor as Described in TSB-M-08(3)S ) for New York State sales tax if the business enters into agreements with residents of New York State under which the residents receive consideration for referring potential customers to the business by links on a Web site or otherwise, and the value of the sales in New York State made by the business through those agreements totals more than $10,000 in the preceding four sales tax quarters. See TSB-M-08(3)S, New Presumption Applicable to Definition of Sales Tax Vendor, and TSB-M-08(3.1)S.

Also see TSB-M-09(3)S, Definition of a Sales Tax Vendor is Expanded to Include Out-of-State Sellers with Related Businesses in New York State, for information on sales tax registration requirements for out-of-state businesses with New York affiliates.

A purchaser who is not otherwise required to be registered for New York State sales tax may purchase fulfillment services from an unaffiliated New York fulfillment service provider and have its tangible personal property located on the premises of the provider without being required to be registered for sales tax in New York State.

If you need help determining if you are required to register because you engage in activity in New York State, contact the department (see Need help?).

If you meet the registration requirements and engage in business activities in New York State without possessing a valid Certificate of Authority, you will be subject to penalty of up to $500 for the first day on which you make a sale or purchase, and up to $200 for each additional day, up to a maximum of $10,000.

Limitations on useContractors cannot use this certificate. They must either:

• issue Form ST-120.1, Contractor Exempt Purchase Certificate, if the tangible personal property being purchased qualifies for exemption as specified by the certificate, or

• issue Form AU-297, Direct Payment Permit, or

• pay sales tax at the time of purchase.

Contractors are entitled to a refund or credit of sales tax paid on materials used in repairing, servicing or maintaining real property, if the materials are transferred to the purchaser of the taxable service in conjunction with the performance of the service. For additional information, see Publication 862, Sales and Use Tax Classifications of Capital Improvements and Repairs to Real Property.

ST-120 (1/11) (back) Instructions

To the PurchaserEnter all the information requested on the front of this form.

You may mark an X in the Blanket certificate box to cover all purchases of the same general type of property or service purchased for resale. If you do not mark an X in the Blanket certificate box, the certificate will be deemed a Single-use certificate. Temporary vendors may not issue a blanket certificate. A temporary vendor is a vendor (other than a show or entertainment vendor), who, in no more than two consecutive quarters in any 12-month period, makes sales of tangible personal property or services that are subject to tax.

This certificate does not exempt prepaid sales tax on cigarettes. This certificate may not be used to purchase motor fuel or diesel motor fuel.

Misuse of this certificateMisuse of this exemption certificate may subject you to serious civil and criminal sanctions in addition to the payment of any tax and interest due. These include:

• A penalty equal to 100% of the tax due;

• A $50 penalty for each fraudulent exemption certificate issued;

• Criminal felony prosecution, punishable by a substantial fine and a possible jail sentence; and

• Revocation of your Certificate of Authority, if you are required to be registered as a vendor. See TSB-M-09(17)S, Amendments that Encourage Compliance with the Tax Law and Enhance the Tax Department’s Enforcement Ability, for more information.

To the SellerIf you are a New York State registered vendor and accept an exemption document, you will be protected from liability for the tax, if the certificate is valid.

The certificate will be considered valid if it was:

• accepted in good faith;

• in the vendor’s possession within 90 days of the transaction; and

• properly completed (all required entries were made).

A certificate is accepted in good faith when a seller has no knowledge that the exemption certificate is false or is fraudulently given, and reasonable ordinary due care is exercised in the acceptance of the certificate.

You must get a properly completed exemption certificate from your customer no later than 90 days after the delivery of the property or the performance of the service. When you receive a certificate after the 90 days, both you and the purchaser are subject to the burden of proving that the sale was exempt, and additional documentation may be required. An exemption certificate received on time that is not properly completed will be considered satisfactory if the deficiency is corrected within a reasonable period. You must also maintain a method of associating an invoice (or other source document) for an exempt sale made to a customer with the exemption certificate you have on file from that customer.

Invalid exemption certificates – Sales transactions which are not supported by valid exemption certificates are deemed to be taxable retail sales. The burden of proof that the tax was not required to be collected is upon the seller.

Retention of exemption certificates - You must keep this certificate for at least three years after the due date of the return to which it relates, or the date the return was filed, if later.

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Form ST-10

COMMONWEALTH OF VIRGINIASALES AND USE TAX CERTIFICATE OF EXEMPTION

(For use by a Virginia dealer who purchases tangible personal property for resale,or for lease or rental, or who purchases materials or containers

to package tangible personal property for sale)

To: _______________________________________________________________________ Date _______________________ , _______(Name of supplier)

______________________________________ _____________________________________ ______________ ______________(Number and street or rural route) (City, town, or post office) (State) (ZIP Code)

The Virginia Retail Sales and Use Tax Act provides that the Virginia Sales and use tax shall not apply to tangible personal propertypurchased for resale; that such tax shall not apply to tangible personal property purchased for future use by a person for taxable lease or rentalas an established business or part of an established business, or incidental or germane to such business, including a simultaneous purchaseand taxable leaseback. The Act provides also that such tax shall not apply to packaging materials such as containers, labels, sacks, cans, boxes,drums or bags if the materials are marketed with a product being sold and become the property of the purchaser.

This Certificate of Exemption may not be used by a using or consuming construction contractor as defined in the Regulations.

The undersigned dealer hereby certifies that all tangible personal property purchased from the above named supplier on and after thisdate will be purchased for the purpose indicated below, unless otherwise specified on each order, and that this Certificate shall remain in effectuntil revoked in writing by the Department of Taxation. (Check proper box below.)

h 1. Tangible personal property for RESALE only.

h 2. Tangible personal property for future use by a person for taxable LEASE OR RENTAL as an established business, or part ofan established business, or incidental or germane to such business, or a simultaneous purchase and taxable leaseback.

h 3. Packaging materials such as containers, labels, sacks, cans, boxes, drums or bags that are marketed with a product being soldand become the property of the purchaser.

Certificate ofName of Dealer_____________________________________________________________ Registration No. _______________________

Trading as ______________________________________________________________________________________________________

Address_____________________________________________________________________ ______________ ______________(Number and street or rural route) (City, town, or post office) (State) (ZIP Code)

Kind of business engaged in by dealer ________________________________________________________________________________

I certify that I am authorized to sign this Certificate of Exemption and that, to the best of my knowledge and belief, it is true and correct,made in good faith, pursuant to the Virginia Retail Sales and Use Tax Act.

By ________________________________________________ ______________________________________________(Signature) (Title)

(If the dealer is a corporation, an officer of the corporation or other person authorized to sign on behalf of the corporation must sign;if a partnership, one partner must sign; if an unincorporated association, a member must sign; if a sole proprietorship, the proprietor must sign.)

Information for supplier—A supplier is required to have on file only one Certificate of Exemption properly executed by the dealer whobuys tax exempt tangible personal property for the purpose indicated hereon.

Virginia Department of Taxation(REV. 10/99)

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Illinois Department of Revenue

CRT-61 Certifi cate of ResaleStep 1: Identify the seller 1 Name __________________________________________

2 Business address _________________________________ _______________________________________________ City State Zip

Step 2: Identify the purchaser3 Name __________________________________________

4 Business address _________________________________ _______________________________________________ City State Zip

5 Complete the information below. Check only one box.

The purchaser is registered as a retailer with the Illinois Department of Revenue. __ __ __ __ - __ __ __ __ .

Account ID number

The purchaser is registered as a reseller with the Illinois Department of Revenue. __ __ __ __ - __ __ __ __ . Resale number

The purchaser is authorized to do business out-of-state and will resell and deliver property only to purchasers located outside the state of Illinois. See Line 5 instructions.

Step 3: Describe the property 6 Describe the property that is being purchased for resale or list the invoice number and the date of purchase. _______________________________________________

_______________________________________________

_______________________________________________

Step 4: Complete for blanket certifi cates 7 Complete the information below. Check only one box.

I am the identifi ed purchaser, and I certify that all of the purchases that I make from this seller are for resale. I am the identifi ed purchaser, and I certify that the following percentage, ______ %, of all of the purchases that I make from this seller are for resale.

Step 5: Purchaser’s signature I certify that I am purchasing the property described in Step 3 from the stated seller for the purpose of resale.

___________________________________ _ _/_ _/_ _ _ _ Purchaser’s signature Date

Note: It is the seller’s responsibility to verify that the purchaser’s Illinois account ID or Illinois resale number is valid and active. You can confi rm this by visiting our web site at tax.illinois.gov and using the Verify a Registered Business tool.

General informationWhen is a Certifi cate of Resale required?Generally, a Certifi cate of Resale is required for proof that no tax is due on any sale that is made tax-free as a sale for resale. The purchaser, at the seller’s request, must provide the information that is needed to complete this certifi cate.

Who keeps the Certifi cate of Resale?The seller must keep the certifi cate. We may request it as proof that no tax was due on the sale of the specifi ed property. Do not mail the certifi cate to us.

Can other forms be used?Yes. You can use other forms or statements in place of this certifi cate but whatever you use as proof that a sale was made for resale must contain the seller’s name and address; the purchaser’s name and address; a description of the property being purchased; a statement that the property is being purchased for resale; the purchaser’s signature and date of signing; and either an Illinois account ID number, an Illinois resale number,

or a certifi cation of resale to an out-of-state purchaser. Note: A purchase order signed by the purchaser may be used as a Certifi cate of Resale if it contains all of the above required information.

CRT-61 (R-12/10)IL-492-3850

When is a blanket certifi cate of resale used? The purchaser may provide a blanket certifi cate of resale to any seller from whom all purchases made are sales for resale. A blanket certifi cate can also specify that a percentage of the purchases made from the identifi ed seller will be for resale. In either instance, blanket certifi cates should be kept up-to-date. If a specifi ed percentage changes, a new certifi cate should be provided. Otherwise, all certifi cates should be updated at least every three years.

Specifi c instructionsStep 1: Identify the sellerLines 1 and 2 Write the seller’s name and mailing address.

Step 2: Identify the purchaserLines 3 and 4 Write the purchaser’s name and mailing address. Line 5 Check the statement that applies to the purchaser’s business, and provide any additional requested information. Note: A statement by the purchaser that property will be sold for resale will not be accepted by the department without supporting evidence (e.g., proof of out-of-state registration).

Step 3: Describe the propertyLine 6 On the lines provided, briefl y describe the tangible personal property that was purchased for resale or list the invoice number and date of purchase.

Step 4: Complete for blanket certifi catesLine 7 The purchaser must check the statement that applies, and provide any additional requested information.

Step 5: Purchaser’s signatureThe purchaser must sign and date the form.

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Following is an affidavit for customers who drop-ship into Illinois, but who are not required to be

registered in the State of Illinois for sales tax. This affidavit will allow customers to provide other

evidence that they are exempt in IL based on registration as a reseller in their home state. The last

paragraph should be completed with the customer’s home state and their home state’s sales tax

registration number. A copy of the customer’s Uniform Sales & Use Tax Certificate – Multijurisdiction or

appropriate state form must also be on file with NewWave Technologies.

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Following is an affidavit for customers who drop-ship into Illinois, but who are not required to be registered in the State of Illinois for sales tax. This affidavit will allow customers to provide other evidence that they are exempt in IL based on registration as a reseller in their home state. The last paragraph should be completed with the customer’s home state and their home state’s sales tax registration number. A copy of the customer’s Uniform Sales & Use Tax Certificate – Multijurisdiction (and appropriate state form when necessary) must also be on file with NewWave Technologies.
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Dear Sir or Madam:

In lieu of a completed form CRT-61 Certificate of Resale as issued by the Illinois Department of Revenue,

____________________________________________________, list purchasing company name

located at ____________________________________________________________________________, list complete address

hereinafter referred to as “Out of State Retailer”, hereby represents the following in order to document

that NewWave Technologies’ sales to “Out of State Retailer”, are sales for resale and therefore not

subject to Illinois sales tax:

“Out of State Retailer” does not have sufficient nexus with the State of Illinois that would require us to

be registered for Illinois sales/use tax purposes. We are not operating as a dealer in Illinois. We do not

have a physical location within Illinois nor do we hold tangible personal property for lease or rental

within Illinois. We do not have any employees or agents operating on our behalf within Illinois. We do

not deliver property into Illinois in a company owned vehicle or other manner except via common

carrier.

All sales by NewWave Technologies to “Out of State Retailer” are for purposes of resale only. NewWave

Technologies will be drop shipping to “Out of State Retailer” ’s customers within Illinois. This affidavit

should meet the requirements for “other evidence” under Illinois Admin. Code section 130.225. “Out of

State Retailer” is registered for sales taxes in the State of _____________ and holds a valid registration #

_________________.

_______________________________________________ _____________________ Signature Title

_______________________________________________ _____________________ Printed Name Date