Form St-134 - Exemption Certificate For Construction Contractors - 2005
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1Form ST-134
Indiana Department of Revenue
Identification of Project
Exemption Certificate for Construction Contractors
or Building Permit #
SF# 50218 R2/ 3-05
Name of Project:
Permit issued by (City)
or (County)
Location Address
City
County
The undersigned certifies that the tangible personal property purchased with this certificate will be incorporated into a structure or improvement
to real estate under a construction contract. The items purchased are exempt from sales tax for the following reason(s):
Materials incorporated into a public street or public utility service (I.C. 6-2.5-5-7).
Check One:
Federal, Indiana State or Local Governmental Agencies (I.C. 6-2.5-5-16).
Prime Contractor
School Building Materials (I.C. 6-2.5-5-23).
Subcontractor
Sales to Nonprofit Organizations not organized primarily for social purposes (I.C. 6-2.5-5-25).
Other, explain use.
A person who issues an exemption certificate, with the intention of unlawfully avoiding the payment of the state gross retail or use tax, commits a Class B
misdemeanor (Indiana Code 6-2.5-9-1).
Name
Signature
Date
Address
Title
TID#
Seller must keep this certificate on file to support exempted sales. Do not send this certificate to the Indiana Department of Revenue.
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