Form St-14a - Sales And Use Tax Certificate Of Exemption - 2015
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1Form ST-14A
COMMONWEALTH OF VIRGINIA
SALES AND USE TAX CERTIFICATE OF EXEMPTION
This Certificate of Exemption is for use exclusively by an OUT-OF-STATE dealer or broker who purchases livestock in
Virginia for immediate transportation out of the Commonwealth of Virginia for resale outside Virginia.
To: ___________________________________________________________________ Date ____________________
Name of Supplier
________________________________________________________________________________________________
Number and Street or Rural Route
City, Town or Post Office
Zip Code
The undersigned out-of-state dealer or broker hereby certifies that the livestock purchased from the above named livestock
dealer on and after this date are purchased for immediate transportation outside the Commonwealth of Virginia for resale
only outside Virginia.
The undersigned out-of-state dealer or broker further certifies that he will immediately notify the Virginia livestock dealer
when any livestock is purchased for any use other than for resale outside Virginia.
Name of Out-of-State Dealer ________________________________________________________________________
Trading As _______________________________________________________________________________________
________________________________________________________________________________________________
Number and Street or Rural Route
City, Town or Post Office
Zip Code
Name of State in which
Out-of-State Dealer is Licensed ________________________ Account Number________________________________
Name of Broker ___________________________________________________________________________________
________________________________________________________________________________________________
Number and Street or Rural Route
City, Town or Post Office
Zip Code
I hereby certify that I am authorized to sign this Certificate of Exemption as an out-of-state dealer or as a broker representing
the above out-of-state dealer and that, to the best of my knowledge and belief, it is true and correct, made in good faith,
pursuant to the Virginia Retail Sales and Use Tax Act.
__________________________________________________
____________________________________________
Signature
Title
If the out-of-state dealer or broker is a corporation, an officer of the corporation or other person authorized to sign on behalf
of the corporation must sign; if a partnership, one partner must sign; if an unincorporated association, a member must sign;
if a sole proprietorship, the proprietor must sign.
Information for the Virginia Livestock Dealer. A livestock dealer is required to have on file only one Certificate of Exemption
properly executed by the out-of-state dealer or broker who purchases livestock for resale outside Virginia.
Va. Dept. of Taxation W ST-14A
6201062
Rev. 09/15
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