Form 3372 - Michigan Sales And Use Tax Certifi Cate Of Exemption - 2012

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Michigan Department of Treasury

Form 3372 (Rev. 08-12)

Michigan Sales and Use Tax Certiﬁ cate of Exemption

DO NOT send to the Department of Treasury. Certiﬁ cate must be retained in the seller’s records. This certiﬁ cate is invalid unless all four sections

are completed by the purchaser.

SECTION 1: TYPE OF PURCHASE

A. One-Time Purchase

C. Blanket Certiﬁ cate

Order or Invoice Number: _____________________

Expiration Date (maximum of four years):_________________

B. Blanket Certiﬁ cate. Recurring Business Relationship

The purchaser hereby claims exemption on the purchase of tangible personal property and selected services made from the vendor listed below. This

certiﬁ es that this claim is based upon the purchaser’s proposed use of the items or services, OR the status of the purchaser.

Vendor’s Name and Address

SECTION 2: ITEMS COVERED BY THIS CERTIFICATE

Check one of the following:

All items purchased.

Limited to the following items: _________________________________________________________________________

SECTION 3: BASIS FOR EXEMPTION CLAIM

Check one of the following:

For Resale at Retail. Enter Sales Tax License Number: _______________________

For Lease. Enter Use Tax Registration Number:_______________________________

The following exemptions DO NOT require the purchaser to provide a number:

For Resale at Wholesale.

Agricultural Production. Enter percentage: ______%

Industrial Processing. Enter percentage: ______%

Church, Government Entity, Nonproﬁ t School, or Nonproﬁ t Hospital (Circle type of organization).

Nonproﬁ t Internal Revenue Code Section 501(c)(3) or 501(c)(4) Exempt Organization (must provide IRS authorized letter with this form).

Nonproﬁ t Organization with an authorized letter issued by the Michigan Department of Treasury prior to June 1994 (must provide copy of

letter with this form).

Rolling Stock purchased by an Interstate Motor Carrier.

10.

Other (explain):

SECTION 4: CERTIFICATION

I declare, under penalty of perjury, that the information on this certiﬁ cate is true, that I have consulted the statutes, administrative rules and other

sources of law applicable to my exemption, and that I have exercised reasonable care in assuring that my claim of exemption is valid under Michigan

law. In the event this claim is disallowed, I accept full responsibility for the payment of tax, penalty and any accrued interest, including, if necessary,

reimbursement to the vendor for tax and accrued interest.

Business Name

Type of Business (see codes on page 2)

Business Address

City, State, ZIP Code

Business Telephone Number (include area code)

Name (Print or Type)

Signature and Title

Date Signed