Fillable Form 13e - Nebraska Energy Source Exempt Sale Certificate printable pdf download

FORM

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Nebraska Energy Source Exempt Sale Certiﬁcate

13E

NAME AND MAILING ADDRESS OF PURCHASER

NAME AND MAILING ADDRESS OF SELLER

Name

Street or Other Mailing Address

City

State

Zip Code

City

State

Zip Code

Check Type of Certiﬁcate

If Blanket is checked, this certiﬁcate is valid until revoked in writing by the purchaser.

Single Purchase

Blanket

Was an energy audit (analysis) completed prior to issuing this certiﬁcate to the seller?

Purchaser’s Account Number

YES

Describe your business operations:

A. Our purchase of electricity or compressed natural gas is exempt from Nebraska sales and use tax because more than 50

percent of the energy charge through meter number(s) _________________________________________ has been properly

determined to be used or directly consumed in: (check appropriate box)

Manufacturing and Processing

Farming

Generation of Electricity

Irrigation

Reﬁning

B. Our purchase of coal, fuel oil, diesel fuel, tractor fuel, coke, nuclear fuel, butane, propane, or gas is exempt from Nebraska

sales and use tax because more than 50 percent of the amount purchased is used or directly consumed in: (check appropriate

box)

Manufacturing and Processing

Farming

Generation of Electricity

Irrigation

Reﬁning

Any purchaser, or the agent thereof, or other person who completes this certiﬁcate for any purchase which is not otherwise exempted from the

sales and use tax under the Nebraska Revenue Act, as amended, shall in addition to any tax, interest, or penalty otherwise imposed, be subject to a

penalty of $100.00 or ten times the tax, whichever amount is larger, for each instance of presentation and misuse. With regard to a blanket certiﬁcate,

said penalty shall apply to each purchase made during the period the blanket certiﬁcate is in effect. Under the penalties of law, I declare that I am

authorized to sign this certiﬁcate, and to the best of my knowledge and belief, it is correct and complete.

sign

here

Authorized Signature of Purchaser

Title

Date Issued

NOTE: Sellers must keep this certiﬁcate as part of their records. Do not send it to the Nebraska Department of Revenue.

INSTRUCTIONS

energy analysis should be completed every few years to ensure that

WHO MUST FILE. A Nebraska Energy Source Exempt Sale

the exemption is still valid.

Certiﬁcate must be ﬁled by every person claiming a sales and use tax

exemption when it has been determined that more than 50 percent of

Energy consumed directly in manufacturing and processing,

the purchase of electricity, coal, gas, fuel oil, diesel fuel, tractor fuel,

irrigation, farming, reﬁning, or generation of electricity, as herein

coke, nuclear fuel, butane, propane, or compressed natural gas is used

deﬁned, is a qualiﬁed use. Energy consumed in heating, cooling, or

or directly consumed in manufacturing and processing, irrigation,

lighting that portion of the facility directly used in manufacturing and

farming, reﬁning, or generation of electricity.

processing, irrigation, farming, reﬁning, or generation of electricity,

is also considered to be for an exempt use.

WHERE TO FILE. The Form 13E must be given to the seller at

the time of purchase.

Examples of energy use that are not a qualiﬁed use include, but are

not limited to, ofﬁce spaces, bathrooms, storage areas, freezer storage,

DETERMINING PERCENT OF EXEMPT USE

housing, shop areas and transporting of materials to and from the

To properly determine whether your purchase of energy for which

direct manufacturing area.

you are claiming an exemption is exempt from tax, an energy analysis

If you checked exemption block A, the purchase and use of energy

must be completed. The analysis can be completed by your company

will be exempt from tax, when it has been determined that more than

or you can hire an outside ﬁrm to conduct the analysis. You must

50 percent of the energy charge through a single meter is consumed

be able to document how the percentage was determined. An

11-2005

6-354-1994 Rev.

Supersedes 6-354-1994 Rev. 12-2001

Form 13e - Nebraska Energy Source Exempt Sale Certificate

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