Form St-5 Sst - Streamlined Sales And Use Tax Agreement - Certificate Of Exemption
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1
2Certificate of Exemption
Georgia
Streamlined Sales and Use Tax Agreement
This is a multi-state 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 Multi-state 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
_________________________________________________________________________________________
Seller’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
Construction
Wholesale trade
03
13
Finance and insurance
Business services
04
14
Information, publishing and communications
Professional services
05
15
Manufacturing
Education and health-care services
06
16
Mining
Nonprofit organization
07
17
Real estate
Government
08
18
Rental and leasing
Not a business
09
19
Retail trade
Other
(explain)__________________________
10
20
5
. Reason for exemption. Circle the letter that identifies the reason for the exemption.
Federal government
Agricultural production #_____________________
(department)_________________
A
H
State or local government
Industrial production/manufacturing #___________
(name)_________________
B
I
Direct pay permit #__________________________
C
Tribal government (name)_______________________
J
Foreign diplomat # ____________________________
Direct mail #_______________________________
D
K
Other
E
Charitable organization #________________________
(explain)______________________________
L
Religious or Educational organization _____________
F
Resale #_____________________________________
G
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
__________________________________________________________________________________________________________________
ST-5 SST Exemption Certificate
(8/27/09)
(Revised by the State of Georgia on 12/03/10)
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