Form 5000a - Resale Certificate
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1ARIZONA FORM
Arizona
5000A
Resale Certificate
This certificate is to be completed by the purchaser and furnished to the vendor who shall retain it. Incomplete certificates must not be accepted in good faith.
SELLER INFORMATION
Seller:
Street Address:
City, State, Zip Code:
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 Certificate
Period:
Through
CERTIFICATION
A seller that has reason to believe that the certificate is not accurate, complete or applicable to the transaction, may
not accept the certificate in good faith and the seller will not be relieved of the burden of proving entitlement to the
exemption. A seller that accepts a certificate 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 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 Certificate will subject the 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
that the information on this Certificate is true, accurate and complete. Further, if purchasing as an agent or officer, I certify
that I am authorized to execute this Certificate on behalf of the purchaser named above.
Signature of purchaser
Date
Title
ADOR 60-2018 (3/00)
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