Wisconsin Sales And Use Tax Exemption Certificate Form (Page 2 of 4) in pdf

Enter CES No., if applicable

Federal and Wisconsin

Governmental Units

The United States and its unincorporated agencies and instrumentalities and any incorporated agency or instrumentality of

the United States wholly owned by the United States or by a corporation wholly owned by the United States.

Any federally recognized American Indian tribe or band in this state.

State of Wisconsin or any agency thereof; Local Exposition District, Professional Baseball Park District, or Professional

Football Stadium District.

Wisconsin county, city, village, or town, including public inland lake protection and rehabilitation district, municipal public

housing authorities, uptown business improvement districts, local cultural arts district, the Wisconsin Aerospace Authority,

the Health Insurance Risk-Sharing Plan Authority, the Wisconsin Quality Home Care Authority, the Fox River Navigational

System Authority, and any Regional Transit Authority in Wisconsin.

Wisconsin public schools, school districts, universities, and technical college districts.

County-city hospitals or UW Hospitals and Clinics Authority.

Sewerage commission, metropolitan sewerage district, or a joint local water authority.

Other

Containers and other packaging, packing, and shipping materials, used to transfer merchandise to customers of the

purchaser.

Trailers and accessories, attachments, parts, supplies, materials, and service for motor trucks, tractors, and trailers which

are used exclusively in common or contract carriage under LC or IC No.

Items or services purchased directly by and used by religious, charitable, educational, scientific, or other organizations

holding a Wisconsin Certificate of Exempt Status. CES No.

Tangible personal property and items, property and goods under s.77.52(1)(b), (c), and (d) to be resold by

on my behalf where

is registered to collect and remit sales tax to the Department of Revenue on such sales.

Tangible personal property, property, items and goods under s.77.52(1)(b), (c), and (d), or services purchased by a Native

American with enrollment #

, who is enrolled with and resides on the

Reservation, where buyer will take possession of such property, items, goods, or services.

Tangible personal property and items and property under s.77.52(1)(b) and (c) becoming a component of an industrial or

municipal waste treatment facility, including replacement parts, chemicals, and supplies used or consumed in operating the

facility.

Portion of the amount of electricity or natural gas used or consumed in an industrial waste treatment facility.

(Percent of electricity or natural gas exempt

Electricity, natural gas, fuel oil, propane, coal, steam, corn, and wood (including wood pellets which are 100% wood) used

for fuel for residential or farm use.

% of Electricity

% of Natural Gas

% of Fuel

Exempt

Residential . . . . . . . . . . . . . . . . . . . . . . . . .

Farm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address Delivered:

Percent of printed advertising material solely for out-of-state use.

Catalogs, and the envelopes in which the catalogs are mailed, that are designed to advertise and promote the sale of

merchandise or to advertise the services of individual business firms.

Other purchases exempted by law. (State items and exemption).

I hereby certify that if the item(s) being purchased are not used in an exempt manner, I will remit use tax on the purchase price at the time of first

taxable use. I understand that failure to remit the use tax may result in a future liability that may include tax, interest, and penalty.

Signature of Purchaser

Print or Type Name

Title

Date

-2-

Wisconsin Sales And Use Tax Exemption Certificate Form Page 2

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