Form ST-19
COMMONWEALTH OF VIRGINIA
SALES AND USE TAX CERTIFICATE OF EXEMPTION
(For use by shipping lines engaged in interstate or foreign commerce and
by ship building companies engaged in building, converting or
repairing ships or vessels used or to be used in
interstate or foreign commerce)
To: _________________________________________________________________ Date ____________________________
(Name of supplier)
___________________________________________________
_______________________________________________
____________________________________
(Number and street or rural route )
(City, town, or post office)
(State and ZIP Code)
The Virginia Retail Sales and Use Tax Act provides that the Virginia sales and use tax shall not apply to the kinds and
classes of tangible personal property shown in Items 1 through 3 below when purchased for the purposes and under
conditions set out in Items 1 through 3 below.
The undersigned purchaser hereby certifies that all tangible personal property purchased from the above named supplier
on and after this date will be purchased for the purpose indicated below, unless otherwise specified on each order and
that this Certificate shall remain in effect until revoked in writing by the Department of Taxation. (Check proper box below.)
1. Ships or vessels used or to be used exclusively or principally in interstate or foreign commerce.
2. Tangible personal property used directly in the building, conversion, repair or alteration of ships or vessels plying
the high seas. either in intercoastal trade between ports in this State and ports in other States of the United States
or its territories or possessions, or in foreign commerce between ports in this State and ports in foreign countries.
3. Fuel and supplies for use or consumption aboard ships or vessels plying the high seas, either in intercoastal trade
between ports in this State and ports in other States of the United States or its territories or possessions, or in
foreign Commerce between ports in this State and ports in foreign countries, for delivery directly to such
ships or vessels.
Certificate of
Name of purchaser _________________________________________ Registration No., if any ______________________
Trading as ___________________________________________________________________________________________
Address _____________________________
_______________________________________________
____________________________________
(Number and street or rural route )
(City, town, or post office)
(State and ZIP Code or Country)
Kind of business engaged in by purchaser _________________________________________________________________
I
certify that I am authorized to sign this Certificate of Exemption 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.
By ___________________________________________________
____________________________________________
(Signature)
(Ttitle)
(If the purchaser is a corporation, an officer of the corporation or other person authorized to sign on behalf of corporation
must sign; if a partnership, one partner must sign; if a sole proprietorship, the proprietor must sign.)
Information for supplier. A supplier is required to have on file only one Certificate of Exemption properly executed by
each purchaser buying or leasing tax exempt property under this certificate.
Department Of Taxation
6201067, Rev. 06/05