Form 5000 - Transaction Privilege Tax Exemption Certificate
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1
2Arizona Form
Transaction Privilege Tax Exemption Certificate
5000
• Do not use Form 5000 to claim sale for resale. Use Form 5000A.
• Do not use Form 5000 if you are a non-TPT licensed contractor. Use Form 5000M.
This Certificate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009.
The purpose of the
Certificate is to document and establish a basis for state and city tax deductions or exemptions. It is to be filled
out completely by the purchaser and furnished to the vendor at the time of the sale.
The vendor shall retain
this Certificate for single transactions or for the specified period as indicated below.
Incomplete Certificates are
not considered to be accepted in good faith.
Only one category of exemption may be claimed on a Certificate.
A. Purchaser’s Name and Address:
B. Check Applicable Box:
Name
Single Transaction Certificate
Address
Period From
Through
City
State
ZIP Code
(You must choose specific dates for which the certificate will be valid. You
are encouraged not to exceed a 12 month period. However, a certificate will be
considered to be accepted in good faith for a period not to exceed 48 months if the
Vendor’s Name
vendor has documentation the TPT license is valid for each calendar year covered
in the certificate.)
C. Choose one transaction type per Certificate:
Transactions with Native Americans & Native
Transactions with a Business
American Businesses (See reason #12.)
Arizona Transaction Privilege Tax (TPT) License Number
Tribal Business License Number OR
Tribal Number
SSN / EIN
Name of Tribe
Other Tax License Number
Transactions with a U.S. Government entity
(See reasons #9 and #10.)
If no license, provide reason:
Transaction with a Foreign Diplomat (See reason #13.)
.
Precise Nature of Purchaser’s Business
D. Reason for Exemption:
Check the box indicating one of the more common exemptions provided below, or use Box 14 or 15 to cite the appropriate
authority for another exemption (deduction).
Refer to
for a
complete list of state and city exemptions (deductions) and the business classes (codes) under which the deductions apply.
1. Tangible personal property to be leased or rented in the ordinary course of the purchaser’s licensed business.
2. Tangible personal property to be incorporated into a taxable contracting project, or a maintenance, repair, replacement or alteration
project.
3. Food, drink, or condiments purchased by a restaurant business.
4. Pipes or valves four inches in diameter or greater to be used for transportation of oil, natural gas, artificial gas, water or coal slurry.
5. Railroad rolling stock, rails, ties, and signal control equipment.
6. Machinery or equipment used directly in the following business activities:
Manufacturing, processing or fabricating.
Job printing.
Refining or metallurgical operations.
Extraction of ores or minerals from the earth for commercial purposes.
Extraction of, or drilling for, oil or gas from the
earth for commercial purposes.
7. Other income producing capital assets. (Cities only.)
8. Food, drink or condiments for consumption within the premises of any prison, jail or other institution under the jurisdiction of the
state department of corrections, the department of public safety, the department of juvenile corrections or a county sheriff. Food,
drink, condiments or accessories purchased by a school district for consumption at a public school within the district during school
hours.
9. Tangible personal property sold or leased directly to the United States Government or its departments or agencies by a manufacturer,
modifier, assembler or repairer. (Retail, personal property rental and mining classifications only.)
10. Fifty percent of the gross proceeds or gross income from the sale of tangible personal property directly to the United States
Government or its departments or agencies. (Retail classification only.)
Continued on page 2
ADOR 10308 (7/17)
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