Sstgb Form F0003 - Streamlined Sales And Use Tax Agreement - Certificate Of Exemption
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5Certificate of Exemption
Streamlined Sales and Use Tax Agreement
This is a multistate form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they qualify to
claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide this exemption
certificate (or the data elements required on the form) to a state that would otherwise be due tax on this sale.
The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state, if the
purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-based exemption on a sale
made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption.
1.
Check if you are attaching the Multistate Supplemental form.
If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.
2.
Check if this certificate is for a single purchase and enter the related invoice/purchase order #
.
3.
Please print
Name of purchaser
Business Address
City
State
Zip Code
Purchaser’s Tax ID Number
State of Issue
Country of Issue
If no Tax ID Number
FEIN
Driver’s License Number/State Issued ID Number
Foreign diplomat number
Enter one of the following:
State of Issue:
Number:
Name of Seller from whom you are purchasing, leasing or renting
Reseller’s address
City
State
Zip Code
4.
Type of business. Circle the number that describes your business
Accommodation and food services
Transportation and warehousing
01
11
Agricultural, forestry, fishing, hunting
Utilities
02
12
03
Construction
13
Wholesale trade
04
Finance and insurance
14
Business services
05
Information, publishing and communications
15
Professional services
06
Manufacturing
16
Education and health-care services
Mining
Nonprofit organization
07
17
Real estate
Government
08
18
09
Rental and leasing
19
Not a business
10
Retail trade
20
Other
(explain)__________________________
5
. Reason for exemption. Circle the letter that identifies the reason for the exemption. (Shaded items are not available in Washington State.
Shaded “#” indicates no number is required.)
A
Federal government
(department)
H
Agricultural production #
State or local government (name)
Industrial production/manufacturing #
B
I
C
Tribal government
(name)
J
Direct pay permit #
D
Foreign diplomat #
K
Direct mail #
E
Charitable organization #
L
Other
(explain)
F
Religious or educational organization #
G
Resale (Reseller Permit #)
6.
Sign here. I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.
Signature of Authorized Purchaser
Print Name Here
Title
Date
SSTGB Form F0003 Exemption Certificate (5/10/11)
(Revised by the State of Washington on 9/22/11)
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