St: Ex-A1-Se Form - Application For Sales Tax Certificate Of Exemption

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A
D
R
LABAMA
EPARTMENT OF
EVENUE
ST: EX-A1-SE
1/16
RESET
S
U
T
D
Application for Sales Tax Certificate of Exemption
ALES AND
SE
AX
IVISION
for Statutorily Exempt Entities
An Alabama Sales Tax Certificate of Exemption shall be used by persons, firms, or corporations coming under the provisions of the
Alabama Sales Tax Act who are not required to have a Sales Tax License.
PLEASE COMPLETE EACH LINE APPLICABLE TO YOUR ENTITY. A SALES TAX CERTIFICATE OF EXEMPTION WILL
NOT BE ISSUED UNTIL THIS APPLICATION IS PROPERLY COMPLETED.
1. Federal Employer Identification Number (FEIN) _________________________________ 2. Business Telephone (______)_______________
3. ____________________________________________________________________________________________________________________
NAME OF PERSON(S), FIRM, CORPORATION, ASSOCIATION, CO-PARTNERSHIP MAKING APPLICATION.
__________________________________________________________________ 4. Contact Person _________________________________
GIVE TRADE NAME
5. Mailing address of home office ________________________________________________________________________________________
P.O. BOX OR STREET NO. OR R.F.D.
____________________________________________________________________________________________________________________
CITY
COUNTY
STATE
ZIP CODE
6. Location ____________________________________________________________________________________________________________
CITY
STREET AND NO. OF HWY.
COUNTY
ZIP CODE
Location must be exact street number or, if on highway or rural route, give details of location. If more than one location, please
attach schedule. _________________________________________________________ 7. Number of businesses in Alabama __________
8. Would you like to receive a courtesy email notification to renew your certificate?
No
Yes If yes, you must provide email address: ________________________________________________________________
9. The Business is:
For Profit
Non-Profit
10. REASON EXEMPTION CLAIMED ____________________________________________________________________________________
(PRIVATE SCHOOL, UNITED WAY, ETC.) (PROVIDE CODE SECTION OR ACT NUMBER IF KNOWN)
11. Please attach a list of Board Members and a copy of the articles of incorporation. (CEO, CFO, or Executive Director may sign.)
NOTE
As a prerequisite to renewal of a certificate, the annual report must be filed as required by law.
Signed ____________________________________________________
Signed ____________________________________________________
Title _______________________________ Date __________________
Title _______________________________ Date __________________
Attn.: Exemption Unit
STExemptionUnit@revenue.alabama.gov
MAIL OR EMAIL APPLICATION TO:
Alabama Department of Revenue
Sales and Use Tax Division
P.O. Box 327710
Montgomery, AL 36132-7710
REVENUE DEPARTMENT USE ONLY
Examiner’s Remarks _____________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
Examiner _____________________________________ Date ___________________
Supervisor’s Recommendation ____________________________________________________________________________________________
________________________________________________________________________________________________________________________
Supervisor _____________________________________ Date ___________________

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