Form 51a260 - Streamlined Sales And Use Tax Agreement-Certificate Of Exemption January 2012
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1
251A260 (1-12)
Certificate of Exemption
Streamlined Sales and Use Tax Agreement
This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they
qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide
this exemption certificate (or the data elements required on the form) to a state that would otherwise be due tax on this sale.
The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state,
if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-based
exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an
entity-based exemption.
1
Check if you are attaching the Multistate Supplemental form.
If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.
2
Check if this certificate is for a single purchase and enter the related invoice/purchase order # ____________ .
3
Please print
Name of purchaser
Business address
City
State
Zip code
Purchaser’s tax ID number
State of issue
Country of issue
If no tax ID number,
FEIN
Driver’s license number/State issued ID number
Foreign diplomat number
enter one of the following:
state of issue
number
Name of seller from whom you are purchasing, leasing or renting
Seller’s address
City
State
Zip code
4
Type of business. Circle the number that describes your business.
01 Accommodation and food services
11 Transportation and warehousing
02 Agricultural, forestry, fishing, hunting
12 Utilities
03 Construction
13 Wholesale trade
04 Finance and insurance
14 Business services
05 Information, publishing and communications
15 Professional services
06 Manufacturing
16 Education and health-care services
07 Mining
17 Nonprofit organization
08 Real estate
18 Government
09 Rental and leasing
19 Not a business
10 Retail trade
20 Other (explain)__________________________________
5
Reason for exemption. Circle the letter that identifies the reason for the exemption.
H Agricultural production # _______________________
A Federal government (department) _________________________
I
Industrial production/manufacturing # _____________
B State or local government (name) _________________________
J
Direct pay permit # ____________________________
C Tribal government (name) _______________________________
K Direct mail # _________________________________
D Foreign diplomat # _____________________________________
L Other (explain) _______________________________
E Charitable organization # ________________________________
F Religious or educational organization # _____________________
G Resale # _____________________________________________
6
Sign here. I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.
Signature of authorized purchaser
Print name here
Title
Date
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Parent category: Financial