Form St-5 - Sales Tax Exempt Purchaser Certificate - Massachusetts Department Of Revenue
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1
2Rev. 8/98
Massachusetts
Form ST-5
Department of
Sales Tax Exempt Purchaser Certificate
Revenue
To be Completed by Exempt Organization
Name
Address
City
State
Zip
Exemption number
Issue date
Certificate expires on
Certification is hereby made that the organization named above is an exempt purchaser under Massachusetts General Laws, Chapter 64H, sections
6(d) or 6(e). All purchases of tangible personal property or services by this organization are exempt from taxation under said chapter to the extent that
such property or services are used in the conduct of the business of the purchaser. Any abuse or misuse of this certificate by any tax-exempt organiza-
tion or any unauthorized use of this certificate by any individual constitutes a serious violation and will lead to revocation.
Signed under the penalties of perjury.
Signature
Title
Date
Warning: Willful misuse of this certificate may result in criminal tax evasion sanctions of up to one year in prison and $10,000 ($50,000 for
corporations) in fines.
To be Completed by Vendor
Vendor’s name
Check applicable box:
Single Purchase Certificate
Blanket Certificate
Attach detailed receipts/invoices or describe property on the back of this form.
General Information
Notice to Vendors
The organization or agency must have obtained a Certificate of Exemp-
Vendors must obtain a copy of the Certificate of Exemption (Form ST-2)
tion (Form ST-2) from the Commissioner of Revenue, certifying that it is
at the time of any sale to an exempt organization. Vendors should verify
entitled to exemption and must attach a photocopy of Form ST-2 to this
the validity of the certificate presented to them by checking the expiration
certificate. The vendor must retain a completed Form ST-5 accompanied
date on the certificate. Vendors must not honor a Certificate of Exemp-
by a copy of Form ST-2 in the same manner as other sales tax records.
tion that has expired. Staple a copy of Form ST-2 to this form.
For further information regarding the requirements for retaining records,
NOTE: Governmental agencies maintain ST-2 Certificates of Exemption
see Massachusetts Regulation 830 CMR 62C.25.1.
that have an expiration date of “None.”
Vendors should call the Bureau of Desk Audit at (617) 887-6970 if they
have any questions regarding a Certificate of Exemption which is pre-
sented to them.
If you have any questions about completing this certificate, please contact:
Massachusetts Department of Revenue
Bureau of Desk Audit
Exempt Organization Unit
200 Arlington Street
Chelsea, MA 02150
(617) 887-6970
This form is approved by the Commissioner of Revenue and may be reproduced.
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