Form 5060 Project Exemption Certificate
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MISSOURI DEPARTMENT OF REVENUE
FORM
TO BE GIVEN TO
5060
CUSTOMER SERVICES DIVISION
YOUR CONTRACTOR
PROJECT EXEMPTION CERTIFICATE
(REV. 1-2008)
NAME OF EXEMPT ENTITY ISSUING THE CERTIFICATE
MISSOURI TAX EXEMPTION NUMBER
___ ___ ___ ___ ___ ___ ___ ___
ADDRESS
CITY
STATE
ZIP
__ __ __ __ __
BEGIN DATE FOR PROJECT
PROJECTED COMPLETION DATE
PROJECT NUMBER
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
DESCRIPTION OF PROJECT
PROJECT LOCATION
EXPIRATION DATE
__ __ / __ __ / __ __ __ __
THIS EXEMPTION DOES NOT APPLY TO THE PURCHASE OR RENTAL OF MACHINERY, EQUIPMENT, OR TOOLS BY THE
CONTRACTOR OR SUB-CONTRACTOR.
Give a signed copy of this certificate, along with a copy of your Missouri Sales/Use Tax Exemption Letter to each contractor
and/or subcontractor who will be purchasing tangible personal property for use in this project. It is your responsibility to
ensure the validity of the certificate. You must issue a new certificate if any of the information changes.
EXEMPT ENTITY’S AUTHORIZED SIGNATURE
DATE
__ __ / __ __ / __ __ __ __
The Missouri exempt entity named above hereby authorizes the purchase, without sales tax, of tangible personal property to be incor-
porated or consumed in the construction project identified herein and no other, pursuant to Section 144.062, RSMo. I also declare
under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any
tax exemption, credit or abatement if I employ such aliens.
NAME OF PURCHASING CONTRACTOR
ADDRESS
CITY
STATE
ZIP
__ __ __ __ __
Contractors present this to your supplier in order to purchase the necessary materials tax exempt.
NOTE: COMPLETE AND SIGN BOTTOM PORTION IF EXTENDING CERTIFICATE TO YOUR SUBCONTRACTOR.
NAME OF PURCHASING SUBCONTRACTOR
ADDRESS
CITY
STATE
ZIP
__ __ __ __ __
SIGNATURE OF CONTRACTOR
DATE
__ __ / __ __ / __ __ __ __
MO 860-3042 (1-2008)
This publication is available upon request in alternative accessible format(s).
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