Form 31-014a - Iowa Sales Tax Exemption Certificate - 2011 , Form 31-014b - Exemption Certificate Instructions - 2012
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1
2Iowa Department of Revenue
Iowa Sales Tax Exemption Certificate
This document is to be completed by a purchaser whenever claiming exemption from sales/use tax.
Certificates are valid for up to three years. Seller: Keep this certificate in your files.
Purchaser: Keep a copy of this certificate for your records. Do not send to Department of Revenue.
Purchaser Name
Seller Name
Address
Address
City
State
ZIP
City
State
ZIP
General Nature of Business
Telephone Number
Purchaser is claiming exemption for the following reason:
Resale
Leasing
Processing
Purchaser is doing business as a:
Retailer
Qualifying Farm Machinery/Equipment
Sales Tax Permit No. (if required): __________________
Qualifying Industrial Machinery/Equipment
Retailer Car Dealer
DOT No.: ________________
Qualifying Replacement Parts
Qualifying Computer
Wholesaler
Farmer
Lessor
Manufacturer
Nonprofit Hospital
Pollution Control Equipment
Recycling Equipment
Private Nonprofit Educational Institution
Research and Development Equipment
Governmental Agency including public schools
Direct Pay (permit no. required): __________________
Qualifying Residential Care Facility
Non-Profit Museum
Other: ____________
Other: __________________________________
Description of Purchase: Attach additional information if necessary. ________________________________________________________________
Under penalty of perjury, I swear or affirm that the information on this form is true and correct.
Signature of Purchaser: _________________________________________ Title: __________________________ Date: ________________
31-014a (08/16/11)
Iowa Department of Revenue
Iowa Sales Tax Exemption Certificate
This document is to be completed by a purchaser whenever claiming exemption from sales/use tax.
Certificates are valid for up to three years. Seller: Keep this certificate in your files.
Purchaser: Keep a copy of this certificate for your records. Do not send to Department of Revenue.
Purchaser Name
Seller Name
Address
Address
City
State
ZIP
City
State
ZIP
General Nature of Business
Telephone Number
Purchaser is claiming exemption for the following reason:
Resale
Leasing
Processing
Purchaser is doing business as a:
Retailer
Qualifying Farm Machinery/Equipment
Sales Tax Permit No. (if required): __________________
Qualifying Industrial Machinery/Equipment
Retailer Car Dealer
DOT No.: ________________
Qualifying Replacement Parts
Qualifying Computer
Wholesaler
Farmer
Lessor
Manufacturer
Nonprofit Hospital
Pollution Control Equipment
Recycling Equipment
Private Nonprofit Educational Institution
Research and Development Equipment
Governmental Agency including public schools
Direct Pay (permit no. required): __________________
Qualifying Residential Care Facility
Non-Profit Museum
Other: ____________
Other: __________________________________
Description of Purchase: Attach additional information if necessary. ________________________________________________________________
Under penalty of perjury, I swear or affirm that the information on this form is true and correct.
Signature of Purchaser: _________________________________________ Title: __________________________ Date: ________________
31-014a (08/16/11)
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