Illinois Department Of Revenue St-589 Certificate Of Eligibility For Sales And Use Tax Exemption - Community Water Supply
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Illinois Department of Revenue
ST-589
Certificate of Eligibility for Sales and Use Tax
Exemption — Community Water Supply
The seller must keep this certificate. The community water supply must always complete Steps 1 through 4. If the purchaser is a
contractor, the contractor also must complete Step 5.
Step 1: Identify the seller
Name
Address
_______________________________________________
_______________________________________________
Number and street
Phone
( _______ ) ______________________________________
_____________________________________________________
City
State
ZIP
Step 2: Identify the community water supply
Name
Date of purchase
_______________________________________________
___ ___/___ ___/___ ___ ___ ___
Month
Day
Year
Address
Illinois EPA Water Supply Facility Number:
_____________________________________________
Number and street
IL
___________________________________________________
____ ____ ____ ____ ____ ____ ____
City
State
ZIP
Phone
(_______)______________________________________
FEIN ____ ____ - ____ ____ ____ ____ ____ ____ ____
Step 3: Identify the tangible personal property you are purchasing
Description of tangible personal property _____________________________________________________________________
_______________________________________________________________________________________________________
Vehicle identification number (VIN) or other identifying number for items that must be titled or registered with an agency of
Illinois state government __________________________________________________________________________________
Step 4: Identify how the tangible personal property will be used and sign below
This is a purchase by the community water supply identified above, and
(check one)
this tangible personal property is being purchased and used in the construction or maintenance of structures and
physical plant owned by the community water supply and will be physically incorporated into the structures and physical
plant; or
this tangible personal property will not be physically incorporated into the structures and physical plant owned by a
community water supply but is being purchased for use in the construction or maintenance of a community water
supply. Note: This exempt purpose can be claimed only when the purchaser is the community water supply, not a
contractor.
Sign here
Under penalties of perjury, I state that I have examined this certificate and to the best of my knowledge it is true, correct, and
complete. I further state that the above-identified community water supply meets all the requirements of Section 2-5(39) of
the Retailers' Occupation Tax Act and that the not-for-profit corporation is in good standing and has not been dissolved. If
the not-for-profit corporation is a foreign not-for-profit corporation, I also state that it has obtained a certificate of authority to
conduct affairs in Illinois and that the certificate has not been withdrawn.
_______________________________________________________________________________________
__ __/__ __/__ __ __ __
Signature of chief executive officer or duly authorized designee
Date
Step 5: If the purchaser is a contractor, also complete the following and sign below
Contractor's Name _________________________________
Address
_______________________________________________
Number and street
Phone
(_______)______________________________________
_____________________________________________________
City
State
ZIP
I am a contractor and the tangible personal property I am purchasing will be physically incorporated into the structures and
physical plant owned by a community water supply in fulfillment of a construction contract with a not-for-profit corporation that
operates the community water supply and is eligible for this exemption. Under penalties of perjury, I state that I have examined
this certificate and, to the best of my knowledge, it is true, correct, and complete.
_______________________________________________________________________________________
__ __/__ __/__ __ __ __
Contractor's signature
Date
If you have questions about the community water supply sales and use tax exemption, call the Illinois Department of Revenue
at (217) 785-6606. Additional forms are available on our website at tax.illinois.gov.
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
ST-589 (N-10/15)
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