Arizona Form 5006 - Transaction Privilege And Use Tax Overhead Exemption Certificate
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1
2Arizona Department of Revenue
ARIZONA FORM
5006
Transaction Privilege and Use Tax
Overhead Exemption Certifi cate
This exemption Certifi cate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009
This exemption does not apply to city taxes.
This Certifi cate is to be completed by the purchaser and furnished to the vendor.
Issued To: ____________________________________________________________________________________________________________
(name of vendor)
Vendors shall retain this Certifi cate.
Incomplete Certifi cates may not be accepted in good faith.
Purchaser Information
Purchaser Information
AZ Transaction Privilege License No.
Purchaser’s Business Name and Address
Other Tax License Number
Name of Other State/County
Reason for no Tax License:
Government Contractor
Eligible Subcontractor
Precise Nature of Business
This Certifi cate allows the manufacturer, modifi er, assembler or repairer to declare a percentage of total purchases exempt as qualifying purchases
of overhead materials under a contract with the United States government with appropriate title passing clauses. See certifi cation statement below.
Exemption Claimed
Exemption Claimed
Taxable Percentage (%)
%
Exempt Percentage (%)
%
Total:
100%
Check applicable box
All transactions
Single
Other _______________________________________________________
Period limitation if any; From ____________________
To ____________________
Note: If a limitation is noted, this Certifi cate continues in force from the date of signature through the stated period, unless canceled by the purchaser
or the vendor.
Certifi cation
Certifi cation
This Certifi cate is only for use by purchasers claiming full or partial exemption for overhead materials for use by a government contrac-
This Certifi cate is only for use by purchasers claiming full or partial exemption for overhead materials for use by a government contrac-
tor who is a manufacturer, modifi er, assembler or repairer, or a direct subcontractor of the government contractor, pursuant to a contract
tor who is a manufacturer, modifi er, assembler or repairer, or a direct subcontractor of the government contractor, pursuant to a contract
between the government contractor and the United States government in which overhead is covered by the appropriate title passing
between the government contractor and the United States government in which overhead is covered by the appropriate title passing
clauses.
clauses.
Any abuse, misuse, or unauthorized use of this Certifi cate constitutes a serious violation and will lead to revoca-
Any abuse, misuse, or unauthorized use of this Certifi cate constitutes a serious violation and will lead to revoca-
tion of the Certifi cate and its attendant privileges. Misuse of this Certifi cate will subject the purchaser to payment
tion of the Certifi cate and its attendant privileges. Misuse of this Certifi cate will subject the purchaser to payment
of the ARS § 42-5009 amount equal to any tax, penalty or interest. Willful misuse of this Certifi cate will subject the
of the ARS § 42-5009 amount equal to any tax, penalty or interest. Willful misuse of this Certifi cate will subject the
purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
I, (print full name) ______________________________________, hereby certify that these purchases are exempt from
I, (print full name) ______________________________________, hereby certify that these purchases are exempt from
Arizona transaction privilege tax and that the information on this Certifi cate is true, accurate and complete. Futher, if
Arizona transaction privilege tax and that the information on this Certifi cate is true, accurate and complete. Futher, if
purchasing as an agent, I certify that I am authorized to execute this Certifi cate on behalf of the purchaser named above.
purchasing as an agent, I certify that I am authorized to execute this Certifi cate on behalf of the purchaser named above.
Signature and Title of purchaser
Signature and Title of purchaser _________________________________________________________________________________________
_________________________________________________________________________________________
Date
Date __________________________________________________
__________________________________________________
Phone number
Phone number _______________________________________________
_______________________________________________
ADOR 20-2016 (4/02)
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