Form Pub. Ks-1526 - Kansas Business Taxes For Motor Vehicle Transactions (Page 41 of 44) in pdf

KANSAS DEPARTMENT OF REVENUE

STATEMENT FOR SALES TAX EXEMPTION ON ELECTRICITY, GAS, OR

WATER FURNISHED THROUGH ONE METER

Please type or print this form and send a completed copy WITH worksheets to your utility company. Complete a form for each meter on

which you are applying for an exemption.

1. ___________________________________________________

_______________________________________________

Address of meter location

Utility account number

2. In accordance with the Kansas Retailers’ Sales Tax Act, the undersigned purchaser states that the (circle one: electricity, gas, water)

sold and furnished by (name of utility company) ___________________________________________________________ through

meter number ________________________ at the above location issued for the following purposes based on annual consumption.

3. __________________________________________________ uses electricity, gas or water for the following purpose (check one):

PURCHASER (Name of individual, company, or organization)

Unless otherwise indicated, the uses below are exempt from state and local sales tax.

�

Agricultural use.

Severing of oil.

(Electricity & gas subject to local sales tax.)

�

Ingredient or component part.

Certain nonprofit corporations exempt from real estate

�

property tax – i.e., adult care homes (nursing homes);

Irrigation of crops.

�

private children’s homes (nursing home foster care, etc.);

Movement in interstate commerce by railroad or public utility.

�

housing for low and limited income elderly and disabled

*Noncommercial educational radio or TV station.

�

persons (includes HUD housing projects); housing for the

Noncommercial residential use.

(Electricity & gas subject

elderly; and group housing for mentally ill, retarded, and

to local sales tax.)

other disabled persons.

�

“

”

TTACH A COPY OF THE

ORDER

FROM THE

*Nonprofit hospital.

�

OARD OF

PPEALS

*Nonprofit museum or historical society.

�

Consumed in the production, manufacturing, processing,

�

*Nonprofit zoo.

mining, drilling, refining, or compounding of tangible

�

*Over-the-air free access radio or TV station. Only the

personal property, or treatment of by-products or wastes

electricity used to produce the broadcast signal is exempt.

of any above processes.

All other utility use is taxable.

�

Domestic violence shelters.

�

Providing taxable services.

�

*Educational institutions and nonprofit trusts, nonprofit

�

*Religious organization exempt from federal taxation

endowment associations and foundations operated for the

under section 501(c)(3) of the federal Internal Revenue

sole benefit of an education institution.

Code.

�

��

*Government entity.

*Other exempt entity

Enter Sales Tax Exemption Identification Number __________________________

4. Kansas Sales Tax Registration Number _____________________ and/or Employer ID Number (EIN) _____________________

Type of business _________________________________________________________________________________________

5. Describe the taxable service; movement in interstate commerce; agricultural use; or property produced, manufactured, etc.

_____________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________

NOTE: Effective January 1, 2006 all sales of water are NOT subject to local (city/county) sales tax. However, all electricity and gas

used to light, heat, cool, clean or maintain equipment, buildings or business facilities (offices, plants, shops, warehouses) are FULLY

TAXABLE. This includes, but is not limited to, electricity and gas for air conditioners, all lighting (including production area), exhaust

fans, freezers, heaters, refrigerators, other appliances and machines.

6. EXEMPT PERCENT

___________ % (See instructions.)

The undersigned purchaser agrees and certifies that: a) this statement is true, correct, and complete; b) the worksheets used to

determine the “Exempt Percent” will be kept by the undersigned and copies of the worksheets and this completed form will be

provided to the utility company); and, c) in the event there is a change in the “Exempt Percent”, a revised statement will be filed

immediately with the utility company. If the electricity, gas, or water exempted from taxation is determined to be taxable at a rate other than

stated above, the undersigned purchaser agrees to reimburse the utility company or KDOR for any amounts assessed as retailers’ sales

or compensating tax, penalties, and/or interest.

(

)

Purchaser:

_______________________________________________________

Phone No.

_____________________________

Individual, company, or organization name

Address: ___________________________________________________________________________________________________

Street, RR, or P.O. Box

City

State

Zip + 4

Authorized Signature: ____________________________________________________________ Date: ______________________

ST-28B (Rev. 8/07)

Form Pub. Ks-1526 - Kansas Business Taxes For Motor Vehicle Transactions Page 41

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