Form St-Be1 Application For Certificate Of Exemption Digital Broadcast Equipment For Radio Or Television Broadcasters, Cable Networks Or Cable Distributors

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ST-BE1 (04/07)
STATE OF GEORGIA
Department of Revenue
Taxpayer Services Division
1800 Century Boulevard NE, Ste. 15311
Clear Form
Atlanta, Georgia 30345-3205
Telephone: (404) 417-6649
APPLICATION FOR CERTIFICATE OF EXEMPTION
DIGITAL BROADCAST EQUIPMENT FOR RADIO
OR TELEVISION BROADCASTERS, CABLE NETWORKS OR CABLE DISTRIBUTORS
PURCHASES MUST BE LIMITED TO PURCHASES OF DIGITAL EQUIPMENT
1. Legal Business Name _________________________________________________________________________
2. D/B/A Name ________________________________________________________________________________
3. Mailing Address __________________________________________ Telephone ( __ ) ____________________
4. Business Location _____________________________________________________ ,Georgia ______________
5. Type of Broadcaster: Television [ ] Radio [ ] Cable Network [ ] Cable Distributor [ ]
6. Will equipment be:
[ ] Purchased
[ ] Leased
[ ] or Both
(MM/DD/YY)
7. Anticipated date purchases or leases will begin: __________________ , be completed: ______________________ .
(MM/DD/YY)
8. List the type of equipment, manufacturer or supplier, and purchase price for which exemption is claimed.
Equipment
Manufacturer or Supplier
Purchase Price
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Attach separate equipment list if needed.
The undersigned hereby certifies that purchases or leases of digital equipment for use in this state comes within the exemption
provisions of O.C.G.A. § 48-8-3(74) and that the equipment will solely be used at the above stated business location.
(MM/DD/YY)
GEORGIA CERTIFICATE OF REGISTRATION NO. ______________________________________ DATE ___________________
(IF APPLICABLE)
SIGNATURE ____________________________________________________________________ TITLE ___________________

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