Application For Retail Sales Tax Exemption Certificate For Livestock Nutrient Management Equipment & Facilities Form
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1
2
3Application for Retail Sales Tax Exemption Certificate for
Livestock Nutrient Management Equipment & Facilities
Unified Business Identifier (UBI) Tax Registration Number
(if applicable)
Federal Employer Identification Number (FEIN) (if applicable)
Type of Entity:
Individual
Corporation
Sole Proprietor
Partnership
Other (Explain) ______________
Applicant Name
Farm/Feeding Operation Name
Farm/Feeding Operation Address
City
State
Zip Code
Mailing Address (if different)
City
State
Zip Code
Phone Number (
)
E-mail Address
I, the undersigned applicant, certify (check one):
I am licensed to produce milk under chapter 15.36 RCW and have a certified dairy nutrient management plan.
My Milk Producer License number is:
Date Dairy Nutrient Management Plan approved:
I own an animal feeding operation and have a permit issued under chapter 90.48 RCW
State Waste Discharge and/or National Pollutant Discharge Permit number: _____________________
Date State Waste Discharge and/or National Pollutant Discharge Permit issued:
I own an animal feeding operation and have a nutrient management plan approved by a conservation
district as meeting natural resource conservation service field office technical standards guidelines, and I
possess an Exemption Certificate for Replacement Parts and/or Services for Farm Machinery and
Equipment issued by the Department of Revenue under RCW 82.08.855.
Date Nutrient Management Plan approved:
Name of Approving Conservation District:
Exemption Certificate for Replacement Parts and/or Services for Farm Machinery and Equipment
number:
I, the undersigned applicant, understand that the sales and use tax exemption is limited to purchases:
Of qualifying equipment and services as explained on pages two and three of this application; and
Made after a livestock nutrient management plan is certified under chapter 90.64 RCW, approved as part
of the permit issued under chapter 90.48 RCW, or is approved by a conservation district as meeting
natural resource conservation service field office technical guide standards.
Applicant Name
Title
Applicant Signature
Date
Send completed application to:
Department of Revenue
Taxpayer Account Administration
Attn: Tax Examination & Assessments
PO Box 47476
Olympia, WA 98504-7476
Keep a copy of this application for your records
1
REV 40 2421 (06/05/09)
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