Form Dr 1260 - Sales Tax Exempt Certificate Electricity & Gas For Domestic Consumption
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1DR 1260 (08/25/04)
COLORADO DEPARTMENT OF REVENUE
1375 SHERMAN STREET
DENVER CO 80261
(303) 238-SERV(7378)
SALES TAX EXEMPT
CERTIFICATE
ELECTRICITY & GAS
FOR DOMESTIC CONSUMPTION
NOTE: Exemption certificate must be signed and filed with your proper utility company. The utility company will exempt the
account from sales taxes on utilities, except for the taxes of those local entities which do not allow this exemption.
Name of Utility Company
Street Address or P.O. Box No.
City
State
ZIP
Name of Applicant (name and address as shown exactly on the utility billing)
Street Address or P.O. Box No.
City
State
ZIP
Utility Account No.
For the purpose of this exemption, the term "residential use" has the following meaning: the use of gas or electricity by
the individual customer exclusively for domestic purposes such as lighting, refrigeration, cooking, water heating, space
heating and air conditioning, in a private home or individual living unit served through a single meter or a master metered
multi-unit apartment, condominium, townhouse or mobile/trailer home used exclusively for domestic purposes.
Residential use includes service to buildings appurtenant to the residence, including garages, barns and other minor
buildings for use of the residents served through the residential meter.
Owners of multi-unit apartments, mobile/trailer home parks or condominium and townhouse associations, who are
being billed through a master meter and who are taking service under a commercial rate, but nevertheless qualify for
this exemption because the use is exclusively for domestic purposes, must file this form with their proper utility company.
If, upon audit of the account by the Department of Revenue, a determination is made that the account does not meet
the requirements as outlined above, taxes, penalties, and interest may be assessed to the owner claiming exemption.
Under penalties of perjury, I swear or affirm that the gas and/or electric service which is billed to the above applicant, under a commercial rate, by
the supplier named herein is used exclusively for residential use and therefore qualifies for exemption from Colorado State Sales and Use Tax.
Authorized Signature (owner, partner or corporate officer)
Title
Date
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