Form Cert-142 - Items Used Directly In The Renewable Energy And Clean Energy Technology Industries - Connecticut Department Of Revenue Services

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Department of Revenue Services
State of Connecticut
25 Sigourney Street Ste 2
Hartford CT 06106-5032
CERT-142
(New 10/10)
Items Used Directly in the Renewable Energy
and Clean Energy Technology Industries
General Purpose:
For purchases exempt under Conn. Gen. Stat. §12-412(117)(A)
The purchaser of machinery, equipment,
tools, materials, supplies, and fuel uses this certifi cate to
of a solar energy electricity generating system, passive or active
establish the item(s) being purchased will be used directly in
solar water or space heating system, or geothermal resource
the renewable energy and clean energy technology industries.
system, use CERT-140, Solar Heating Systems, Solar Electricity
Generating Systems, and Ice Storage Cooling Systems.
If the machinery, equipment, tools, materials, supplies, and
Statutory and Regulatory Authority: Conn. Gen. Stat.
fuel are not used in the manner described above, a purchaser
who claimed an exemption owes use tax on the total price of
§12-412(117)(B), as added by 2010 Conn. Pub. Acts 75, §11.
any items purchased under this exemption.
Name of purchaser
Address
CT Tax Registration Number
Federal Employer ID Number
(If none, explain.)
Name of seller
Address
CT Tax Registration Number
Federal Employer ID Number
(If none, explain.)
Check appropriate box and provide written description of each item purchased in the space provided.
Machinery
Equipment
Tools
Materials
Supplies
Fuel
Check one box:
Blanket certifi cate
Certifi cate for one purchase only
Declaration by Purchaser: The item(s) described above qualify for exemption under Conn. Gen. Stat. §12-412(117)(B). In accordance
with Conn. Gen. Stat. §12-412(117)(B), the purchase of the item(s) is exempt from sales and use taxes.
I declare under penalty of law that I have examined this document (including any accompanying schedules and statements) and, to the best
of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document
to the Department of Revenue Services (DRS) is a fi ne of not more than $5,000 or imprisonment for not more than fi ve years, or both.
Name of purchasing company
By:
Authorized signature of owner or offi cer
Title
Date

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