Form Pub Ks-1520 - Kansas Exemption Certificates Page 28
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49KANSAS DEPARTMENT OF REVENUE
INTERSTATE COMMON CARRIER EXEMPTION CERTIFICATE
The undersigned motor carrier certifies that the tangible personal property purchased from:
Seller
:
_________________________________________________________________________________________________
Business Name
Address:
_________________________________________________________________________________________________
Street, RR, or P.O. Box
City
State
Zip + 4
is exempt from Kansas sales and compensating use tax for the following reason:
K.A.R. 92-19-28 and K.A.R. 92-20-18 exempt the sale of rolling stock (including buses and trailers), repair or
replacement materials and parts for rolling stock, gasoline, distillate and other motor fuels purchased for
rolling stock when purchased by a motor carrier qualifying as a public utility, for immediate and direct use in
interstate commerce. The qualifying motor carrier may be engaged in interstate commerce exclusively, or in
both interstate and intrastate commerce.
Description of tangible personal property purchased: _______________________________________
__________________________________________________________________________________________
The undersigned motor carrier further certifies that he or she qualifies as a public utility on the following basis:
Check one box and complete the information requested.
‰
I have common carrier authority to haul regulated commodities. I will use the purchased item(s) as, or attached to,
rolling stock for the purpose of hauling persons or commodities for hire in interstate commerce. My Motor Carrier
authority is under the name of _________________________. My Motor Carrier number is ____________________.
My USDOT number is ____________________.
‰
I do not have common carrier authority but I am hauling exempt (unregulated) commodities. I will use the purchased
item(s) as, or attached to, rolling stock for the purpose of hauling unregulated commodities for hire in interstate
commerce. My USDOT number is __________________ and under the name of __________________________.
‰
I do not have common carrier authority but I am leased/contracted to a holder thereof, and that I will use the
purchased item(s) as, or attached to, rolling stock to haul persons or commodities for hire in interstate commerce.
I am leased/contracted to: ______________________________________________________________________
Lessor’s Name
Lessor’s Address: ____________________________________________________________________________
Street, RR or P.O. Box
City
State
Zip + 4
Address: _____________________________________________________________________________________
Lessor’s Motor Carrier Number: _________________
Lessor’s USDOT Number: ________________________
CHARGES FOR LABOR SERVICES TO SERVICE, MAINTAIN, OR REPAIR ROLLING STOCK,
INCLUDING BUSES AND TRAILERS, ARE TAXABLE.
The undersigned understands and agrees that if the tangible personal property is not used in interstate commerce,
which is exempt from sales or compensating use tax, the undersigned motor carrier becomes liable for the tax.
Purchaser
: ________________________________________________________________________________________________
Motor Carrier Name
Address:
_________________________________________________________________________________________________
Street, RR, or P.O. Box
City
State
Zip + 4
Authorized Signature: ____________________________________________________
Date
: ___________________
THIS CERTIFICATE MUST BE COMPLETED IN ITS ENTIRETY.
(See reverse for additional information and instructions.)
ST-28J (Rev. 6/12)
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