St-105 Form - Indiana Department Of Revenue General Sales Tax Exemption Certificate
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1Form ST-105
Indiana Department of Revenue General Sales Tax Exemption Certificate
SF# 49065 R2/ 1-05
This form is not to be used as an Agricultural, Utility, or Vehicle/Watercraft/Aircraft Exemption Certificate. Business Exemption Certificates are not
valid for personal purchases. Unless you are a federal government agency, you must be registered with the Indiana Department of Revenue prior to
using this exemption certificate.
Indiana Taxpayer Identification Number (TID#)
Purchaser Name:
10 digits
LOC#
Street Address:
City:
State:
Zip Code:
Type of Purchase (check one)
Single Purchase
Blanket
Give a brief description of the item(s) to be purchased exempt.
You must indicate (check one) the type of exemption you are claiming for this purchase.
Sale to Retailer, Wholesaler or Manufacturer for Resale Only
Sale of Manufacturing Machinery, Tools and Equipment to be Used Directly in Direct Production
Sales to Nonprofit Organizations, Claiming Exempt Purchases Pursuant to Sales Tax Information Bulletin #10
Sales to Governmental Units (Agencies, Cities, Towns, Municipalities, State Universities)
Sales to the United States Federal Government - show agency name
-
Enter your Federal Identification Number (FID#) here
Other (Explain)
A person who issues an exemption certificate, with the intention of unlawfully avoiding the payment of the state gross retail or use tax, commits a
Class B misdemeanor (Indiana Code 6-2.5-9-1).
/
/
Signature:
Date:
Printed Name:
Title:
Seller must keep this certificate on file to support exempted sales. Do not send this certificate to the Indiana Department of Revenue.
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