State Tax Exemption ID Card
1 Do you hold, or have you previously held, a Nebraska ID number?
PLEASE DO NOT WRITE IN THIS SPACE
If Yes, provide the number:
2 Social Security Number
3 County of Residence
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Street or Other Mailing Address
7 Are you a nontribal Indian of at least
8 Name of Indian Reservation
5 Name of Your Indian Tribe
6 Tribal Enrollment Number
Where You Reside
If Yes, attach Certificate of Blood Quantum
Under penalties of law, I declare that I have examined this application, and to the best of my knowledge and belief, it is correct and complete.
Who May File. Any Native American Reservation Indian who claims exemption from Nebraska state taxes
may file this application. If this application is approved by the Nebraska Department of Revenue (Department),
a Nebraska State Tax Exemption ID Card will be issued to the applicant. This card must be kept by the Native
American Reservation Indian as evidence of his or her exempt status. To document an exemption from Nebraska
taxation, a Native American Reservation Indian must file a
Nebraska Exemption Certificate for Native American
26, with the retailer, employer, or county official at the time the exemption is claimed.
When and Where to File. This application may be filed with the Nebraska Department of Revenue,
PO Box 98903, Lincoln, NE 68509-8903. Please make a copy of this application for your files.
Any change of address must be reported by filing a Nebraska Application for State Tax Exemption ID Card,
Form 25. A change of address to a location off the reservation ends the cardholder’s exempt status and the
Nebraska State Tax Exemption ID Card must be returned to the Department.
Lines 5 and 6. If you are a member of a recognized American Indian tribe, put the name of the tribe and
your tribal enrollment number in the blanks provided.
Line 7. If you are not a member of a recognized American Indian tribe, but are a person of one-quarter or
more Native American Indian blood, attach a copy of the Certificate of Blood Quantum from the Bureau of
Line 8. Put the name of the Nebraska Indian reservation where you reside in the blank provided. If you do not
live on a Nebraska Native American Indian reservation, there is no exemption allowed, so do not file this form.
Taxpayer Assistance. For additional information, contact the Nebraska Department of Revenue,
PO Box 98903, Lincoln, NE 68509-8903, call 800-742-7474 (NE and IA), or 402-471-5730.
Mail this application to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.
Retain a copy for your records.
Supersedes 7-125-1976 Rev. 9-2012