Arizona Form 5000a - Arizona Resale Certificate - 2002
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1Arizona
ARIZONA FORM
5000A
Resale Certifi cate
This Certifi cate is to be completed by the purchaser and furnished to the vendor who shall retain it. Incomplete certifi cates must not be accepted in good faith.
SELLER INFORMATION
SELLER INFORMATION
Seller:
Street Address:
City, State, Zip Code:
PURCHASER INFORMATION
PURCHASER INFORMATION
1 Purchaser:
License number:
Street Address:
City, State, Zip Code:
2 I am engaged in the business of:
3 The property is purchased for resale and will be resold in the ordinary course of business.
4 Description of the property being purchased
5 Check Applicable Box:
Single Purchase Certifi cate
Period:
Through
CERTIFICATION
CERTIFICATION
A seller that has reason to believe that the certifi cate is not accurate, complete or applicable to the transaction, may
A seller that has reason to believe that the certifi cate is not accurate, complete or applicable to the transaction, may
not accept the certifi cate in good faith and the seller will not be relieved of the burden of proving entitlement to the
not accept the certifi cate in good faith and the seller will not be relieved of the burden of proving entitlement to the
exemption. A seller that accepts a certifi cate in good faith will be relieved of the burden of proof and the purchaser
exemption. A seller that accepts a certifi cate in good faith will be relieved of the burden of proof and the purchaser
may be required to establish the accuracy of the claimed exemption as provided in ARS § 42-5022. Subsequent
may be required to establish the accuracy of the claimed exemption as provided in ARS § 42-5022. Subsequent
use or consumption of the tangible personal property by the purchaser other than the sale in the ordinary course
use or consumption of the tangible personal property by the purchaser other than the sale in the ordinary course
of business will subject the purchaser to the Arizona use tax. Willful misuse of this Certifi cate will subject the
of business will subject the purchaser to the Arizona use tax. Willful misuse of this Certifi cate will subject the
purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
I, (print full name) ______________________________________, hereby certify that these purchases are for resale and
I, (print full name) ______________________________________, hereby certify that these purchases are for resale and
that the information on this Certifi cate is true, accurate and complete. Further, if purchasing as an agent or offi cer, I certify
that the information on this Certifi cate is true, accurate and complete. Further, if purchasing as an agent or offi cer, I certify
that I am authorized to execute this Certifi cate on behalf of the purchaser named above.
that I am authorized to execute this Certifi cate on behalf of the purchaser named above.
Signature of purchaser
Signature of purchaser __________________________________________________________________
__________________________________________________________________ Date
Date _________________________
_________________________
Title
Title _________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
ADOR 60-2018 (8/02)
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Parent category: Financial