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Form 51a111 - Certificate Of Exemption, Machinery For New And Expanded Industry - 2007

51A111 (1-07)

CERTIFICATE OF EXEMPTION

Commonwealth of Kentucky

MACHINERY FOR NEW AND EXPANDED INDUSTRY

DEPARTMENT OF REVENUE

IMPORTANT: Certificate not valid unless completed in full.

This certificate may be executed only for purchases, leases or rentals of tangible personal property which qualify for

exemption under KRS 139.170, KRS 139.480(10) and Regulation 103 KAR 30:120. The certificate may be executed by

either: (1) a manufacturer or production processor; or (2) jointly by a contractor and the manufacturer or production processor

in any case in which a contractor under contract with the manufacturer or production processor does, in fact, purchase, lease

or rent such property.

THE UNDERSIGNED HEREBY CERTIFIES: That the machinery to be purchased, leased or rented from

Name of Vendor, Lessor or Renter

Address

constitutes “machinery for new and expanded industry,” as defined in Sales and Use Tax Regulation 103 KAR 30:120, and

that this machinery is to be installed at

Name, if any, and Address of Plant Location

The undersigned agrees that in the event it is determined that any of the property described below is not tax-exempt, the

undersigned will immediately report and pay the required tax measured by the purchase price or by the lease or rental payment

of the property.

Cost of machinery to be purchased_____________________Purchase order number_________________________

Description of machinery to be purchased

Describe manufacturing function of machinery

Name of Manufacturer or Production Processor

Name of Contractor Under Contract with the Manufacturer

or Production Processor

Name of Subcontractor

Permit Account Number

Job Number/Contract Number

Signature

Title

Signature

Title

Date

Address

Contractor’s Note: This certificate may not be used to purchase or rent/lease construction equipment or consumable supplies used in fulfilling a contract.

Caution: Sellers failing to obtain a completed certificate will be held liable for the sales and use tax pursuant to the good faith provisions of KRS 139.270.

A seller of tangible personal property shall be relieved from the sales and use tax only if he maintains a file of these certificates for a period of not less than

four years as provided by KRS 139.720.

Form 51a111 - Certificate Of Exemption, Machinery For New And Expanded Industry - 2007

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