Tax Information Publication Form (Page 2 of 2) in pdf

EXEMPTION CERTIFICATE

CERTAIN POWER FARM EQUIPMENT, REPAIRS, PARTS, OR ACCESSORIES

This is to certify that the power farm equipment, repairs, parts, or accessories described below,

purchased or repaired on or after ___________ (date) from

_____________________________(Selling Dealer's Business Name) is purchased, repaired,

leased, licensed, or rented for the following purpose:

( ) Power farm equipment or irrigation equipment for exclusive use in the agricultural production

of crops or products, as produced by those agricultural industries included in s. 570.02(1), F.S.,

( ) Power farm equipment or irrigation equipment for exclusive use in fire prevention and

suppression work for such crops or products, as produced by those agricultural industries

included in s. 570.02(1), F.S., or

( ) Repairs to, or parts and accessories for, qualifying power farm equipment or irrigation

equipment for exclusive use in the agricultural production of crops or products, as produced by

those agricultural industries included in s. 570.02(1), F.S., or

( ) Repairs to, or parts and accessories for, qualifying power farm equipment or irrigation

equipment for exclusive use in fire prevention and suppression work for such crops or

products, as produced by those agricultural industries included in s. 570.02(1), F.S.

POWER FARM EQUIPMENT:

________________________________________________________________________________

__________________________________________________

I understand that if I use the equipment for any purpose other than the ones stated above, I must pay

tax on the purchase or lease price of the taxable item directly to the Department of Revenue. I

understand that if I fraudulently issue this certificate to evade the payment of sales tax, I will be

liable for payment of the sales tax plus a penalty of 200% of the tax and may be subject to

conviction of a third-degree felony.

The exemption specified by the purchaser may be verified by calling 800-352-3671.

Purchaser's Name: ____________________________________________________________

Purchaser's Address: ____________________________________________________________

Name and Title of Purchaser's Authorized Representative:

____________________________________________________________

By: _________________________________________________________

(Signature of Purchaser or Authorized Representative)

Date: _______________________

Tax Information Publication Form Page 2