Form Dr-97 - Suggested Format For Blanket Exemption Certificate Based On Property'S Use

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DR-97
Suggested Format for Blanket Exemption
R. 07/05
Certificate Based on Property’s Use
The Department of Revenue does not supply a blanket certificate of exemption form. We do provide this suggested
format that you may use in accordance with Rule 12A-1.038, Florida Administrative Code (F.A.C.). Generic certificates are
available at your local office supply store for a nominal fee. If you prefer, your printer can prepare a certificate to suit your
particular needs as long as it contains the essential information set out below.
Suggested Format Blanket Exemption Certificate
In Accordance with Rule 12A-1.038, F.A.C.
This is to certify that the tangible personal property purchased, leased, licensed, or rented; or services purchased on or
after_______________(date) from _________________________________________(selling dealer’s business name) is
purchased, leased, licensed, or rented for the following purpose as checked in the space provided below. Note: This is not
intended to be an exhaustive list.
Materials, containers, labels, sacks, bags, or similar
Educational materials, such as glue, paper, paints,
items intended to accompany a product for sale at
crayons, unique craft items, scissors, books, and
other than retail, as provided in section 212.02(14)(c),
educational toys, purchased by child care facilities
Florida Statutes (F.S.), by persons who are not
outlined in s. 402.305, F.S., that hold a current license
required to be registered under s. 212.18(3), F.S.
under s. 402.308, F.S., hold a current Gold Seal
Quality Care designation as provided in s. 402.281,
Incorporation into items of tangible personal property
F.S., and provide employees with basic health
manufactured, produced, compounded, processed, or
insurance as defined in s. 627.6699(12), F.S., as
fabricated for one’s own use, as provided in Rule
provided in s. 212.08(5)(m), F.S.
12A-1.043, F.A.C.
Motor vehicle rented or leased by a dealer who will
Printing of a publication exempt under the provisions
provide the motor vehicle at no charge to a person
of s. 212.08(7)(w), F.S.
whose motor vehicle is being repaired, adjusted, or
Items, such as paper and ink, that will be incorporated
serviced by dealer, as provided in
into and become a component part of a publication
s. 212.0601(4), F.S.
exempt under the provisions of s. 212.08(7)(w), F.S.
Other (include description and statutory citation):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Note: There are other suggested formats for exemption certificates based on the use of the property or services that
are provided in other sections of Rule Chapter 12A-1, F.A.C. and in Tax Information Publications (TIPs) issued by the
Department.
I understand that if I use the property or service for any nonexempt purpose, I must pay tax on the purchase or
lease price of the taxable property or service 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 percent 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)
Title: _________________________________________________________ Date: __________________________
(Title – only if purchased by an authorized representative of a business entity)

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