Form As 2916.1- Certificate For Exempt Purchases (Tangible Personal Property And Exempt Services)

Form AS 2916.1

Commonwealth of Puerto Rico

For seller's use

DEPARTMENT OF THE TREASURY

Rev. Sep 6 13

Invoice, receipt or

CERTIFICATE FOR EXEMPT PURCHASES

transaction number:

(Tangible Personal Property and Exempt Services)

Transaction date: Month _______ Day _____ Year _____

The purpose of this Certificate for Exempt Purchases is to release the merchant seller from his or her obligation of collecting and remitting the sales and

use tax on the sale for which this Certificate for Exempt Purchases is issued.

PART I

MERCHANT SELLER'S INFORMATION

Seller's name

Address

Municipality, State

Zip Code

PART II

PURCHASER'S INFORMATION

1.a. I certify that I am engaged in business in Puerto Rico and that my Merchant's Registration number is:

b. The North American Industry Classification System (NAICS) code that appears on my Merchant's Registration Certificate

and the activity's description is the following: _____________________________________________________________.

2. If you are an agency of the Commonwealth of Puerto Rico or the Federal Government, provide your employer

identification number:

3. If you are a diplomat, provide the tax exemption number that appears on the exemption card issued by the United States Department of State:

and the expiration date: Month __________ Day ______ Year ______

4. If you are an individual affected by a disaster (Section 6080.12 of the Puerto Rico Internal Revenue Code of 2011, as amended (Code)), provide your driver's

license or passport number:

5. Indicate the reason for the exemption or exclusion and provide the requested information, as applicable:

Reseller (Municipal SUT)

Farmer (Bona Fide Farmer's Number

Eligible Reseller

_______________________________________________________)

Manufacturing Plant

Direct Pay Permit (Total Exemption Certificate Number

Business to Business Services (except the services indicated

_______________________________________________________)

in Section 4010.01(nn)(2)(A) of the Code)

Housing Cooperative Ruled by Act 239-2004

Services Provided by Persons which Business Volume is

Diplomat (Country or Mission _______________________________)

$50,000 or Less

Special Acts (Act No. ______________________________________)

Federal Government (Agency ________________________)

Exportation

Commonwealth of Puerto Rico

Individual Affected by a Disaster (Section 6080.12 of the Code)

Manufacture's Wholesale Distributor

(Agency _________________________________________)

6. I am engaged in the business of __________________________________ and I mainly sell ____________________________________.

7. I am purchasing:

Tangible personal property for resale (Municipal SUT)

Raw materials

Machinery and equipment used in manufacturing

Services provided to a business (except the services indicated in Section 4010.01(nn)(2)(A) of the Code

Tangible personal property according to special exemption granted under classifications 5.f. through 5.o. indicated above.

Repair services provided by persons with business volume of $50,000 or less (Section 4020.05(a)(1) of the Code)

Capitalized repair services of tangible personal property or real property

8. Describe the tangible personal property, services, raw materials, or machinery and equipment that you are purchasing:

PART III

PURCHASER'S CERTIFICATION

I hereby declare under penalties of perjury that this certificate has been examined by me, and that to the best of my knowledge and belief all the

information provided herein is true, correct and complete. I also certify that:

I am entitled to claim an exemption as indicated on line 5 of Part II, or I am duly authorized to represent the purchaser in the signature of this Certificate for Exempt

Purchases.

I will only use this certificate to buy taxable items for which I am entitled to claim an exemption or exclusion.

If I acquire taxable items, but I use or consume them for non-exempt purposes in Puerto Rico, I will report and pay the sales and use tax directly to the

Department of the Treasury.

That the Provisional Reseller Certificate, Reseller Certificate or the Eligible Reseller Certificate is in force at the date of the purchase transaction.

Purchaser's name

Purchaser's signature

Address

Telephone

Municipality

State

Zip Code

Retention: Six (6) years.