Form Gr-53 & Ar - Exemption Certificate Form - State Of Arkansas - Department Of Finance And Administration - Sales And Use Tax Section - 2008

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STATE OF ARKANSAS
DEPARTMENT OF FINANCE AND ADMINISTRATION
SALES AND USE TAX SECTION
EXEMPTION CERTIFICATE
GR-53 & AR Code 26-52-517(b)(1), (e), and (f)
I hereby certify that I either hold or am the authorized representative of the holder of
Arkansas Sales/Use Tax Permit Number
, or that I am a
nonresident purchaser or the authorized representative thereof and hold a similar permit
issued by the State of
, Number
, that this is a
current and valid permit number; and that I am exempt from sales and use tax on the
tangible personal property purchased from
I further certify that if any tangible personal property purchased exempt under this
certificate is withdrawn from stock or otherwise used, that I will report the tax due under
Arkansas Sales/Use Tax Law and Rules.
Description of the merchandise to be purchased: (Please give a specific identification of
items purchased. If needed an additional statement may be attached hereto.)
The merchandise purchased is exempt for the following reason:
Purchaser's business activity:
______________________________________________________________
Purchaser's Business Name (as stated on permit)
Purchaser's Signature
Address
Title/Position with Company
City, State, Zip
Date
Notice to sellers: A seller who follows all applicable exemption requirements is relieved from any
tax even if it is determined that the purchaser improperly claimed an exemption. However, if the
seller fraudulently fails to collect the sales tax, solicits a purchaser to participate in an unlawful
claim of an exemption, or accepts an entity-based exemption for which an exemption is not
available in the State of Arkansas, the seller will be responsible for the sales tax due on the
transaction.
ST391
REV 01/01/2008

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