Certificate Of Exemption - E-595 - Keiger Direct
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1
2E-595E
Streamlined Sales Tax Agreement
4
Web-Fill
6-04
Certificate of Exemption
PRINT
CLEAR
Warning to purchaser:
This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for
knowing if they qualify to claim exemption from tax in the state that is due tax on this sale. The state that is due tax
on this sale will be notified that you claimed exemption from sales tax. You will be held liable for any tax and interest, as well
as civil and criminal penalties imposed by the member state, if you are not eligible to claim this exemption. Sellers may not
accept a certificate of exemption for sales sourced within the state if an exemption does not apply in the seller’s
state.
Enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.
Check one:
Single purchase certificate. Relates to invoice/purchase order #
.
Blanket certificate. If checked, this certificate continues in force until canceled by the purchaser.
Name of Purchaser
Business Address
City
State
Zip Code
Purchaser’s Tax ID Number
State of Issue
Country of Issue
If No Tax ID Number,
FEIN
Driver’s License Number/State Issued ID Number
Foreign Diplomat Number
Enter One of the Following:
State of Issue
Number
Name of Seller From Whom You Are Purchasing, Leasing, or Renting
Seller’s Address
City
State
Zip Code
Type of Business. Check the number that describes your business.
01 Accommodation and food services
11 Transportation and warehousing
02 Agricultural, forestry, fishing, and hunting
12 Utilities
03 Construction
13 Wholesale trade
04 Finance and insurance
14 Business services
05 Information, publishing, and communications
15 Professional services
06 Manufacturing
16 Education and health-care services
07 Mining
17 Nonprofit organization
08 Real estate
18 Government
09 Rental and leasing
19 Not a business
10 Retail trade
20 Other
(explain)
Reason for Exemption. Check the letter that identifies the reason for the exemption.
A
Federal government
H
Agricultural production #
(department)
B
State or local government
I
Industrial production/manufacturing #
(name)
C Tribal government
J
Direct pay permit #
(name)
D Foreign diplomat #
K
Multiple points of use (services, digital goods, or computer
software delivered electronically)
E
Charitable organization #
L
Direct mail #
F
Religious or educational organization #
M
Other (explain)
G Resale #
I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.
Signature of Authorized Purchaser
Print Name Here
Title
Date
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Parent category: Financial