Exemption Certificate For Sales To Native Americans Or Tribal Councils Form
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2City of Tempe
P. O. Box 5002
660 S. Mill Avenue, Suite 105
Tempe, AZ 85280
480-350-8327
Management Services Department
Tax and License Division
Exemption Certificate
For Sales To Native Americans
Or Tribal Councils
INSTRUCTIONS:
Please complete both sides of this certificate. Incomplete certificates are not valid. This
certificate is not a blanket exemption.
A new certificate must be completed for each
transaction.
Date:
________________________________
Purchaser Name ________________________________
Seller Name
________________________________
Address
________________________________
Address
________________________________
City/State/Zip
________________________________
City/State/Zip
________________________________
Phone #
________________________________
Seller’s Phone #
________________________________
Contact Person
________________________________
Sales Rep Name
________________________________
Phone #
________________________________
Phone #
________________________________
I hereby certify that the following purchase(s): (Attach list if more space is needed)
Date
Invoice #
Description of Purchase(s)
____________
__________________
________________________________________________________
are exempt from Tempe Privilege Tax as a Native American sale and that all three of the following criteria have
occurred on the reservation:
1)
Solicitation and placement of the order has occurred on the _______________________________
reservation; and
2)
Delivery of the tangible personal property has been made by the seller or the seller’s agent to
_______________________________ reservation; and
3)
Payment for the purchase originates from _______________________________ reservation.
NOTE: If any one of the three criteria did not occur on the reservation, the sale is taxable for Tempe purposes.
J:\CM\Exemption Certificate_Native Americans
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