Fillable Form 13 - Nebraska Resale Or Exempt Sale Certificate printable pdf download

Nebraska Resale or Exempt Sale Certificate

Form

for Sales Tax Exemption

Name and Mailing Address of Purchaser

Name and Mailing Address of Seller

Name

Legal Name

Street Address (Do not use PO Box)

Street or Other Mailing Address

City

State

Zip Code

City

State

Zip Code

Check Type of Certificate

Single Purchase

If single purchase is checked, enter the related invoice or purchase order number ______________________________________.

Blanket

If blanket is checked, this certificate is valid until revoked in writing by the purchaser.

I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason:

Check One

Purchase for Resale (Complete Section A.)

Exempt Purchase (Complete Section B.)

Contractor (Complete Section C.)

Section A — Nebraska Resale Certificate

Description of Property or Service Purchased

I hereby certify that the purchase, lease, or rental of ________________________________________________________________from the seller

listed above is exempt from the Nebraska sales tax as a purchase for resale, rental, or lease in the normal course of our business. The property or service

will be resold either in the form or condition in which it was purchased, or as an ingredient or component part of other property or service to be resold.

I further certify that we are engaged in business as a:

Wholesaler

Retailer

Manufacturer

Lessor

Description of Product or Service Sold, Leased, or Rented

___________________________________________________________________________________________________________________.

Nebraska Sales Tax Permit Number is 01-_________________________________.

If none, state the reason _____________________________________________________________________________________________________,

or Foreign State Sales Tax Number__________________________________________ State __________________________________________.

Section B — Nebraska Exempt Sale Certificate

The basis for this exemption is exemption category ______ (insert appropriate number for the category of exemption described on the reverse side).

If exemption category 2 or 5 is claimed, enter the following information:

Description of Items Purchased

Intended Use of Items Purchased

_________________________________________________________________________________________________________________________.

If exemption category 3 or 4 is claimed, enter your Nebraska Exemption Certificate number. 05 -______________________________

Do not enter your Federal Employer ID Number.

If exemption category 6 is claimed, the seller must enter the following information and sign this form below:

Description of Items Sold

Date of Seller’s Original Purchase

Was tax paid when purchased by seller?

Was item depreciable?

c Yes

c No

c Yes

c No

Section C — For Contractors Only

1. Purchase of building materials or fixtures.

As an Option 1 or Option 3 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above are exempt

from Nebraska sales tax. My Nebraska Sales or Use Tax Permit Number is: _____________________________________________________.

2. Purchases made by an Option 2 contractor under a Purchasing Agent Appointment on behalf of_________________________

(exempt entity)

________________________________________.

As an Option 2 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above is exempt from

Nebraska sales tax pursuant to the attached Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17.

Any purchaser, agent, or other person who completes this certificate for any purchase which is not for resale, lease, or rental in the regular course of the

purchaser’s business, or is not otherwise exempted from sales and use taxes is subject to a penalty of $100 or ten times the tax, whichever amount is larger, for

each instance of presentation and misuse. With regard to a blanket certificate, this penalty applies to each purchase made during the period the blanket certificate

is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct and complete.

sign

here

Authorized Signature

Title

Date

Authorized Signature Name (please print)

Do not send this certificate to the Nebraska Department of Revenue. Keep it as part of your records.

Sellers cannot accept incomplete certificates.

10-2014

6-134-1970 Rev.

revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729

Supersedes 6-134-1970 Rev. 3-2009