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Form 31-113a - Iowa Sales Tax Exemption Certificate - Energy Used In Processing Or Agriculture - 2013

Iowa Department of Revenue

Iowa Sales Tax Exemption Certificate

Energy Used in Processing or Agriculture

This document is to be completed by a purchaser to claim exemption from sales/use tax.

This form is to be completed and provided to the seller of the energy used in processing or agriculture to exempt

future purchases from sales tax. Certificates are valid for up to three years.

For Prior Period: To obtain a refund of sales tax previously paid on energy used for processing or agriculture,

use form IA 843. Worksheets and examples for completing an energy study can be found on the sales tax forms

page of our website at . An energy study must be attached to the IA 843 in order to receive a

refund.

Purchaser

Seller Name

Address

City, State, ZIP

General Nature of Business

Daytime Telephone Number:

FUEL PURCHASED:

Electricity

Gas

Other, specify: ________________

REASON FOR EXEMPTION:

Grain Drying

Raising Livestock

Generating Electricity

Data Center

Processing

Manufacturing

Other, specify: _____________________

Effective Date of this Exemption Certificate: _____ / _____/ _____

Meter No. _____________________________

Utility Account No. _______________________

% Exempt +

% Taxable = 100%

SUPPORTING DOCUMENTATION

If fuel is not metered, attach an explanation of the method of purchase and storage.

Documentation supporting the exemption must be provided with this certificate in order for a seller to accept the

exemption certificate. The acceptance of a properly-completed certificate relieves the seller of liability. The

documentation must be specific when listing processing or agricultural activities. All taxable activities must also be

listed except that they may be combined into more general categories such as lighting, office, heating, air conditioning,

etc. “Fuel” includes gas, electricity, water, heat, steam, and any other tangible personal property consumed in

creating heat, power, or steam.

Under penalties of perjury, I swear or affirm that the information on and attached to this form is true and correct as to

every material matter.

Authorized Signature of Owner, Partner, or Corporate Officer: ____________________________________

Title: __________________________________________ Date: __________________

31-113a (07/01/13)

Form 31-113a - Iowa Sales Tax Exemption Certificate - Energy Used In Processing Or Agriculture - 2013

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