Form 26 - Nebraska Exemption Certificate For Native American Reservation Indians
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1Nebraska Exemption Certificate
FORM
nebraska
for Native American Reservation Indians
26
RESET FORM
department
of revenue
• Read instructions on reverse side
NAME & MAILING ADDRESS OF NATIVE AMERICAN RESERVATION INDIAN
NAME & MAILING ADDRESS OF RETAILER, EMPLOYER, OR COUNTY OFFICIAL
Name
Name
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
County
Nebraska State Tax Exemption I.D. Card
Invoice Number or Description of Property
Number or Social Security Number
Type of Exemption Claimed
Individual income tax on income earned from sources within the
Motor vehicle excise tax on a motor vehicle registered at a
boundaries of an Indian reservation in Nebraska.
location within the boundaries of an Indian reservation in
Nebraska.
Sales and use tax on tangible personal property and other taxable
services where possession is taken within the boundaries of an
Personal property tax on property having an actual situs
Indian reservation in Nebraska.
within the boundaries of an Indian reservation in Nebraska.
Blanket Certificate
If this block is checked, this certificate
covers all recurring purchases for a period not to exceed three
Other
years from the date of issuance. (See specific instructions).
Withholding tax on wages earned for services performed within the
boundaries of an Indian reservation in Nebraska.
Under penalty of law, I declare that I have examined this certificate and that it is, to the best of my knowledge and belief, true and
correct. I also declare that I am entitled to the exemption indicated above as a native American reservation Indian.
sign
here
Signature of Native American Reservation Indian
Date
7-127-76 Rev. 1-96
Supersedes 7-127-76 Rev. 4-93
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