Form Stec-Sst - Certificate Of Exemption - Streamlined Sales And Use Tax Agreement
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STEC-SST
Rev. 8/09
Certifi cate of Exemption – Streamlined Sales and Use Tax Agreement
This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if
they qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required
to provide this exemption certifi cate (or the data elements required on the form) to a state that would otherwise be due tax
on this sale.
The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member
state, if the purchaser is not eligible to claim this exemption. A seller may not accept a certifi cate of exemption for an entity-
based exemption on a sale made at a location operated by the seller within the designated state if the state does not allow
such an entity-based exemption.
1.
Check if you are attaching the Multi-state Supplemental form.
If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.
2.
Check if this certifi cate is for a single purchase and enter the related invoice/purchase order #
.
3.
(Please print)
Name of purchaser
Business address
City
State
ZIP code
Purchaser’s tax ID number
State of issue
Country of issue
If no tax ID number
FEIN
Driver’s license number/state-issued ID number
Foreign diplomat number
enter one of the following:
State of issue
Number
Name of seller from whom you are purchasing, leasing or renting
Seller’s address
City
State
ZIP code
4. Type of business. Check the box next to the number that describes your business.
01 Accommodation and food services
11 Transportation and warehousing
02 Agricultural, forestry, fi shing, hunting
12 Utilities
03 Construction
13 Wholesale trade
04 Finance and insurance
14 Business services
05 Information, publishing and communications
15 Professional services
06 Manufacturing
16 Education and health-care services
07 Mining
17 Nonprofi t organization
08 Real estate
18 Government
09 Rental and leasing
19 Not a business
10 Retail trade
20 Other (explain)
5. Reason for exemption. Check the box next to the letter that identifi es the reason for the exemption.
A
Federal government (department)
H Agricultural production #
B
State or local government (name)
I
Industrial production/manufacturing #
C
Tribal government (name)
J
Direct pay permit #
D
Foreign diplomat #
K Direct mail #
E
Charitable organization #
L Other (explain)
F
Religious or educational organization #
G
Resale #
6. Sign here. I declare that the information on this certifi cate is correct and complete to the best of my knowledge and belief.
Signature of authorized purchaser
Print name here
Title
Date
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