Form Dp-1 - Application For Direct Payment Authorization
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1Indiana Department of Revenue
DP-1
Form
Application for Direct Payment Authorization
State Form 22917
(R6 / 4-13)
A separate application is required for each business location.
Federal Identification Number (9 digits)
Indiana Taxpayer Identification Number (TID)
Location Number (3 digits)
(10 digits)
Business Entity Legal Name (sole proprietors list last name, first name)
DBA
Mailing Address
Location Address (if different)
City
State
Zip Code
Description of Tangible Personal Property to be Purchased Under Direct Payment Permit
___________________________________________________________________________________________________________
I hereby certify that the above statements are correct to the best of my knowledge and that I am duly authorized to sign this application. In
consideration for issuance of this direct payment permit, I agree that I will report and pay Indiana use tax when due directly to the Indiana
Department of Revenue on any nonexempt transaction where a direct payment certificate was issued and sales tax was not paid.
Signed ____________________________________
Title _______________________________
Date ________________
Printed Name _______________________________________________________________________
Telephone Number __________________________________
Email _________________________________________
Information Regarding Direct Payment Permits
To apply for a direct payment permit, you must be registered with
Direct payment authorization may not be used for the purchase
the Indiana Department of Revenue as a retail merchant to collect
of utilities or motor vehicles required to be licensed for highway
sales and use tax. A registered retail merchant may apply for a direct
use or for property purchased in Indiana for storage in Indiana
and subsequent use outside Indiana as provided by the excep-
payment permit enabling the merchant to remit use tax directly to
the state, rather than paying sales tax to their suppliers.
tion contained in IC 6-2.5-3-1 and 2.
Direct payment permits are issued only when the following conditions
Direct payment permits do not certify that the issuer is entitled to an
are established:
exemption and may not be issued to flat bid (lump sum) contractors.
Form ST-105 (general exemption certificate) should be issued if
1.
The taxpayer regularly buys substantial quantities of tangible
contract qualifies for exemption under IC 6-2.5-5.
personal property that may be used for either an exempt or a
nonexempt purpose.
Holders of direct payment permits are required to file a copy of their
2.
There is no reasonable way the exempt or nonexempt use can
direct payment permit with their supplier in lieu of an exemption
be determined at the time of purchase.
certificate.
3.
Adequate records will be maintained by the taxpayer showing
the ultimate uses of all tangible personal property purchased
The tax due must be reported and paid monthly as use tax on Form
and the amount of use tax remitted.
ST-103.
4.
IC 6-2.5-9-3 imposes a personal liability on any employee,
officer, or other person responsible for the remittance of use
For more information regarding Indiana direct payment permits,
tax to the department.
contact the department at (317) 233-4015, or email the department
at
Note: Direct payment authorization may be revoked by the depart-
ment at any time. Taxpayers with expired Registered Retail Merchant
Submit the forms using these methods:
Certificates (RRMCs) will also have direct payment authorization
•
Fax:
(317) 615-2690
revoked.
•
Mail: Indiana Department of Revenue
P.O. Box 6197
Each business location must apply for and receive a separate direct
Indianapolis, IN 46206-6197
payment authorization. A consolidated sales tax filing number may
not be used as a direct payment authorization.
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