Form St-Wd1 - Application For Certificate Of Exemption Material Handling Equipment For A Warehouse Or Distribution Facility

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ST-WD1 (Rev. 02/02)
Department of Revenue
Sales and Use Tax Division
1800 Century Center Boulevard, NE, Ste. 15311
Clear Form
Atlanta, Georgia 30345-3205
Telephone: (404) 417-6649
APPLICATION FOR CERTIFICATE OF EXEMPTION
MATERIAL HANDLING EQUIPMENT
FOR A WAREHOUSE OR DISTRIBUTION FACILITY
NEW FACILITIES AND EXPANSIONS TO EXISTING FACILITIES MUST MEET THE $5 MILLION REQUIREMENT
1. Business trade name_____________________________________________________________________________________
2. Mailing address______________________________________________________Telephone__________________________
3. Business location______________________________________________________________, Georgia__________________
4. Will machinery be:
[ ] Purchased
[ ] Leased
[ ] or Both?
5. Anticipated date purchases/leases will begin:______________________________, be completed:_______________________
6. List type of equipment for which exemption is claimed and estimated cost of each:
Equipment
Cost
________________________________________________________________
_____________________________
________________________________________________________________
_____________________________
________________________________________________________________
_____________________________
________________________________________________________________
_____________________________
________________________________________________________________
_____________________________
Attach separate equipment list if needed
The undersigned hereby certifies that purchases/leases of material handling equipment for a warehouse or distribution facility come
within the exemption provisions of O.C.G.A. § 48-8-3(34.1).
SIGNATURE____________________________________________ ______ DATE __________________________________
(MM/DD/YY)
A Certificate of Exemption (form ST-WD2) will be issued on all qualifying equipment

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