Purchase Exemption Certificate - Kentucky Department Of Revenue printable pdf download

Purchase Exemption Certificate - Kentucky Department Of Revenue

Exemption Number

Name of Exempt Institution

Check Applicable Block

PURCHASE EXEMPTION

Important—Certiﬁ cate not

Blanket

CERTIFICATE

valid unless completed.

Single Purchase

I hereby certify that ___________________________________ is a Kentucky resident, nonproﬁ t educational, charitable or

Name of Exempt Institution

religious institution, or Kentucky historical site, located at ___________________________, Kentucky and that the tangible

personal property, digital property or services to be purchased from _____________________________________________

Name of Vendor

_____________________________________________________________________________________________________________

Address

will be used solely within the exempt function of a charitable, educational or religious institution, or historical site.

Description of property to be purchased: ____________________________________________________________________

_____________________________________________________________________________________________________________

In the event that the property purchased is not used for an exempt purpose, it is understood that I am required to

pay the tax measured by the purchase price of the property.

Any ofﬁ cial or employee who uses this certiﬁ cate to make tax-free purchases for his own personal use or that of

any other person will be subject to the penalties provided in KRS 139.990 and other applicable laws.

Under penalties of perjury, I swear or afﬁ rm that the information on this certiﬁ cate is true and correct as to every

material matter.

Authorized Signature

Title

CAUTION TO SELLER: This certiﬁ cate cannot be issued or used

in any way by a construction contractor to purchase property

Date

to be used in fulﬁ lling a contract with an exempt institution.

Sellers accepting certiﬁ cates for such purchases will be held

DEPARTMENT OF REVENUE

liable for the sales or use tax.

Frankfort, Kentucky 40620

51A126 (12-09)

Purchase Exemption Certificate - Kentucky Department Of Revenue