Form St-121.5 - Exempt Use Certificate For Operators Of Internet Data Centers (Web Hosting)
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2ST-121.5
New York State Department of Taxation and Finance
New York State and Local Sales and Use Tax
(7/11)
Exempt Use Certificate for Operators of
Internet Data Centers (Web Hosting)
Purchaser: Complete this form and give it to the seller.
Purchaser and seller: Read the instructions on the back before completing or accepting this form.
Seller’s information
Name of seller
Street address
City
State
ZIP code
Purchaser’s information
Name of purchaser
Certificate of Authority number
Street address
City
State
ZIP code
The Internet data center is located at the following address within New York State (if different from the address above):
Street address
City
State
ZIP code
Mark an X in the appropriate box:
Single-purchase certificate
Blanket certificate
Part 1 — Exemptions for machinery and equipment
This machinery, equipment, and other tangible personal property will be used in the operation of an Internet data center. It is
exempt from tax because:
• the property will be placed or installed in an Internet data center for use at the center, and
• it will be required for and directly related to the provision of Internet Web site services for sale by the operator of the center.
Part 2 — Exemptions for services to Internet data center property
The percentage of services provided only to the Internet data center is indicated on lines A, B, or C below. The percentage
indicated will be exempt from state and local sales and use tax. (See Part 2 instructions on back. You must indicate a percentage
(0- 100) for this certificate to be valid. If the service provided is completely related to the Internet data center, write 100%.)
A
%
Installing, maintaining, servicing, and repairing qualified tangible personal property
B
%
Maintaining, servicing, and repairing qualified real property
C
%
Protective services
Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I
make these statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local
sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document
with the intent to evade any such tax may constitute a felony or other crime under New York State Law, punishable by a substantial fine
and a possible jail sentence. I understand that this document is required to be filed with, and delivered to the vendor as agent for the Tax
Department for the purposes of section 1838 of the Tax Law and is deemed a document required to be filed with the Tax Department for the
purpose of prosecution of offenses. I also understand that the Tax Department is authorized to investigate the validity of tax exclusions or
exemptions claimed and the accuracy of any information entered on this document.
Type or print name and title of owner, partner, or authorized person of purchase
Signature of owner, partner, or authorized person of purchase
Date prepared
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