Form 51a222 - Certificate Of Exemption For Alcohol Production Facilities

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51A222 (8-11)
Commonwealth of Kentucky
Important—Certificate
DEPARTMENT OF REVENUE
not valid unless completed.
Frankfort
40620
CERTIFICATE OF EXEMPTION
FOR
ALCOHOL PRODUCTION FACILITIES
This certificate may be executed only for those purchases of tangible personal property which qualify for exemption under KRS 139.480(18).
The certificate may be executed by either: (1) A holder of an Alcohol Production Tax Exemption Certificate; or (2) jointly by a contractor
and the holder of an Alcohol Production Tax Exemption Certificate in any case in which a contractor under contract with the certificate
holder does, in fact, purchase such property.
THE UNDERSIGNED HEREBY CERTIFIES: That the materials and equipment to be purchased from
______________________________________________________________________________________________________________
Name of Vendor
______________________________________________________________________________________________________________
Address
will become a part of an alcohol production facility at __________________________________________________________________
Location of Facility
for which the Department of Revenue, as provided by KRS Chapter 247, has issued an Alcohol Production Tax Exemption Certificate. The
undersigned agrees that in the event it is determined that any of the property described below is not tax-exempt, the undersigned will im-
mediately report and pay the required tax measured by the purchase price of the property.
Cost of property to be purchased: ___________________________________________________________________________________
Description of property to be purchased: _____________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
_____________________________________________________________
______________________________________________
Name of Holder of
Name of Contractor Under Contract with Holder of
Alcohol Production Tax Exemption Certificate
Alcohol Production Tax Exemption Certificate
_______________________________
_____________________________
Permit Account Number
Permit Account Number
By ______________________________________________________
By _____________________________________________
Signature
Title
Signature
Title
Date _____________________________________________________
Date ___________________________________________
Address __________________________________________________
Address _________________________________________
_________________________________________________________
_______________________________________________
Contractor’s Note: This certificate may not be used to purchase or rent/lease construction equipment or consumable supplies used in fulfilling a contract.
Caution: Sellers failing to obtain a completed certificate will be held liable for the sales and use tax pursuant to the good faith provisions of KRS
139.270. A seller of tangible personal property shall be relieved from the sales and use tax only if he maintains a file of these certificates for a
period of not less than four years as provided by KRS 139.720.

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