Form 5005 - Prime Contractor'S Certificate Form - Arizona Department Of Revenue

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Arizona Department of Revenue

ARIZONA FORM

5005

Prime Contractor’s Certiﬁ cate

The purpose of this form is to provide a subcontractor with the validation required for tax exemption of a particular project, for a period of time, or until

revoked. This certiﬁ cate establishes responsibility for the transaction privilege tax; therefore, it must be completed by the prime contractor assuming

the contracting transaction privilege tax liability for the contracting project(s). The asterisked (*) items must be completed, otherwise the certiﬁ cate

is not valid. The Department may disregard this certiﬁ cate pursuant to ARS § 42-5075.E if the certiﬁ cate is incomplete or erroneous. If disregarded,

the entity accepting the certiﬁ cate (subcontractor) will have the burden of proving (pursuant to ARS § 42-5075.D), that it is not subject to transaction

privilege tax as a taxable prime contractor.

A. Prime Contractor

* NAME:

* TRANSACTION PRIVILEGE LICENSE #:

* ADDRESS:

AZ Contractor License #:

Telephone #:

B. Subcontractor

* NAME:

* TRANSACTION PRIVILEGE LICENSE #:

* ADDRESS:

AZ Contractor License #: