Form St-14a - Sales And Use Tax Certificate Of Exemption

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Form ST-14A
COMMONWEALTH OF VIRGINIA
SALES AND USE TAX CERTIFICATE OF EXEMPTION
This Certificate of Exemption is for use exclusively by an OUT-OF-STATE dealer or broker who purchases
livestock in Virginia for immediate transportation out of the Commonwealth of Virginia for resale outside Virginia.
To: ____________________________________________________________________________ Date_______________________
(Name of Supplier)
________________________________________________
__________________________________ , Virginia _____________
(Number and Street or Rural Route)
(City, Town or Post Office)
(ZIP Code)
The undersigned out-of-state dealer or broker hereby certifies that the livestock purchased from the
above named livestock dealer on and after this date are purchased for immediate transportation outside the
Commonwealth of Virginia for resale only outside Virginia.
The undersigned out-of-state dealer or broker further certifies that he will immediately notify the Virginia
livestock dealer when any livestock is purchased for any use other than for resale outside Virginia.
Name of Out-of-State Dealer __________________________________________________________________________
Trading As _________________________________________________________________________________________
____________________________________________ _______________________________ , ___________________
(Number and Street or Rural Route)
(City, Town or Post Office)
(State ZIP Code)
Name of State in which
Registration or
Out-of-State Dealer is Licensed ________________________ License Number _________________________________
Name of Broker _____________________________________________________________________________________
____________________________________________ _______________________________ , ___________________
(Number and Street or Rural Route)
(City, Town or Post Office)
(State ZIP Code)
I hereby certify that I am authorized to sign this Certificate of Exemption as an out-of-state dealer or as a
broker representing the above out-of-state dealer and that, to the best of my knowledge and belief, it is true and
correct, made in good faith, pursuant to the Virginia Retail Sales and Use Tax Act.
______________________________________________
________________________________________
(Signature)
(Title)
If the out-of-state dealer or broker is a corporation, an officer of the corporation or other person authorized
to sign on behalf of the corporation must sign; if a partnership, one partner must sign; if an unincorporated
association, a member must sign; if a sole proprietorship, the proprietor must sign.
Information for the Virginia Livestock Dealer. A livestock dealer is required to have on file only one
Certificate of Exemption properly executed by the out-of-state dealer or broker who purchases livestock for resale
outside Virginia.
VA DEPT OF TAXATION 6201062 REV.
04/11

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