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CLEAR FIELDS
01-931
(Rev.2-17/2)
Qualified Research Sales and Use Tax Exemption Certificate
Persons engaged in qualified research who hold a registration number issued by the Comptroller must provide this completed form to
sellers when claiming an exemption from Texas sales and use tax on items that qualify for exemption under Texas Tax Code Section
151.3182. The certificate may serve as a blanket exemption certificate covering all qualifying purchases.
This form may not be used to claim exemption from tax on motor vehicles, including trailers.
Seller Information
Name
Address (Street and number, P.O. Box or route number)
City, State, ZIP code
Phone (Area code and number)
Purchaser Information
Name
Qualified Research registration number
R D
Address (Street and number, P.O. Box or route number)
City, State, ZIP code
Phone (Area code and number)
I, the purchaser named above, claim an exemption from payment of sales and use taxes for the following items:
Description of items to be purchased or on the attached order or invoice
I understand that I will be liable for payment of all state and local sales or use taxes which may become due for failure to comply with the
provisions of the Tax Code and/or applicable law.
I understand that it is a criminal offense to issue an exemption certificate to the seller for taxable items that I know, at the time of purchase,
will be used in a manner that does not qualify for the exemptions found in Tax Code Section 151.3182, and depending on the amount of
tax evaded, the offense may range from a Class C misdemeanor to a felony of the second degree.
Authorized Purchaser's signature
Purchaser's name (Print or type)
Date
This certificate should be furnished to the supplier.
Do not send the completed certificate to the Comptroller of Public Accounts.