Arizona Form 5006 - Transaction Privilege And Use Tax Overhead Exemption Certificate
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1
2ARIZONA FORM
Arizona Department of Revenue
5006
Transaction Privilege and Use Tax
Overhead Exemption Certificate
This exemption Certificate is prescribed by the Department of Revenue pursuant to ARS § 42-5009
This exemption does not apply to city taxes.
This Certificate is to be completed by the purchaser and furnished to the vendor.
Issued To: __________________________________________________________________________________________
(name of vendor)
Vendors shall retain this Certificate.
Incomplete Certificates may not be accepted in good faith.
Purchaser Information
Purchaser's Business Name and Address
AZ. Trans. Priv. Lic. No.
Other Tax License Number
Name of Other State/Country
Reason for no Tax License:
Government Contractor
Eligible Subcontractor
Precise Nature of Business
This Certificate allows the manufacturer, modifier, assembler or repairer to declare a percentage of total purchases exempt as qualifying purchases of
overhead materials under a contract with the United States government with appropriate title passing clauses. See certification statement below.
Exemption Claimed
Taxable Percentage (%)
%
Exempt Percentage (%)
____________ %
Total:
100 %
Check applicable box
All transactions
Single
Other _______________________________________________________
Period limitation if any; From __________________ To __________________
Note: If a limitation is noted, this Certificate continues in force from the date of signature through the stated period, unless canceled by the purchaser
or the vendor.
Certification
This Certificate is only for use by purchasers claiming full or partial exemption for overhead materials for use by a government contractor
who is a manufacturer, modifier, assembler or repairer, or a direct subcontractor of the government contractor, pursuant to a contract
between the government contractor and the United States government in which overhead is covered by the appropriate title
passing clauses.
Any abuse, misuse, or unauthorized use of this Certificate constitutes a serious violation and will lead to
revocation of the Certificate and its attendant privileges. Misuse of this Certificate will subject the purchaser to
payment of the ARS § 42-5009 amount equal to any tax, penalty or interest. Willful misuse of this Certificate will
subject the purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
I, (print full name)
, hereby certify that these purchases are exempt from
Arizona transaction privilege tax and that the information on this Certificate is true, accurate and complete. Further, if
purchasing as an agent, I certify that I am authorized to execute this Certificate on behalf of the purchaser named above.
Signature and Title of purchaser
Date
Phone number
ADOR 60-2016 (9/99)
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