Form St-123 - Ida Agent Or Project Operator Exempt Purchase Certificate

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New York State Department of Taxation and Finance

ST-123

New York State Sales and Use Tax

(7/14)

IDA Agent or Project Operator

Exempt Purchase Certificate

Effective for projects beginning on or after June 1, 2014

This certificate is not valid unless all entries have been completed.

Note: To be completed by the purchaser and given to the seller. Do not use this form to purchase motor fuel or diesel motor fuel exempt

from tax. See Form FT-123, IDA Agent or Project Operator Exempt Purchase Certificate for Fuel.

Name of seller

Name of agent or project operator

Street address

City, town, or village

State

ZIP code

City, town, or village

State

ZIP code

Agent or project operator sales tax ID number

(see instructions)

Single-purchase certificate

Blanket-purchase certificate (valid only for the project listed below)

Mark an X in one:

To the seller:

You must identify the project on each bill and invoice for such purchases and indicate on the bill or invoice that the IDA or agent

or project operator of the IDA was the purchaser.

Project information

I certify that I am a duly appointed agent or project operator of the named IDA and that I am purchasing the tangible personal property or services for use

in the following IDA project and that such purchases qualify as exempt from sales and use taxes under my agreement with the IDA.

Name of IDA

Name of project

IDA project number

(use OSC number)

Street address of project site

City, town, or village

State

ZIP code

Enter the date that you were appointed agent or

Enter the date that agent or project operator

project operator

...........................

................................

status ends

(mm/dd/yy)

Exempt purchases

(Mark an X in boxes that apply)

A. Tangible personal property or services (other than utility services and motor vehicles or tangible personal property

installed in a qualifying motor vehicle) used to complete the project, but not to operate the completed project

B. Certain utility services (gas, propane in containers of 100 pounds or more, electricity, refrigeration, or steam)

used to complete the project, but not to operate the completed project

C. Motor vehicle or tangible personal property installed in a qualifying motor vehicle

Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these

statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use taxes do not

apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evade any such tax

may constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentence. I understand that this

document is required to be filed with, and delivered to, the vendor as agent for the Tax Department for the purposes of Tax Law section 1838 and is

deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. I also understand that the Tax Department

is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document.

Signature of purchaser or purchaser’s representative

Date

(include title and relationship)

Type or print the name, title, and relationship that appear in the signature box