Form Rev-1715 - Exempt Organization Declaration Of Sales Tax Exemption printable pdf download

Form Rev-1715 - Exempt Organization Declaration Of Sales Tax Exemption

REV-1715 AS (10-05)

COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF REVENUE

EXEMPT ORGANIZATION

BUREAU OF BUSINESS TRUST FUND TAXES

PO BOX 280901

DECLARATION OF

HARRISBURG, PA 17128-0901

SALES TAX EXEMPTION

THIS FORM MAY BE PHOTOCOPIED

INSTRUCTIONS:

Vendors may use this declaration to document purchases of tax free items by tax exempt organizations (charitable, religious and

educational organizations and volunteer fire or ambulance companies) holding a valid exemption number issued by the Department of

Revenue where the purchase is $200 or more. The vendor may require the Customer’s Declaration (below) for each such transaction to

demonstrate that the vendor made the tax exempt sale “in good faith.”

Complete each declaration in its entirety. Use a separate declaration for each transaction of $200 or more. Accompany the

declaration with an invoice and a properly completed Exemption Certificate (REV-1220), and maintain these documents for three years.

CUSTOMER’S DECLARATION

As an authorized representative of a tax-exempt organization, I declare that the property and/or

services purchased or leased in the name of the exempt organization set forth below, as described

on the attached invoice, are being purchased for an exempt use under Pennsylvania Sales Tax law.

Authorized Signature

(

)

Print Name/Title

Phone No.

Name of Exempt Organization

Sales Tax Exemption No.

(Must have a 75-prefix)

VENDOR’S DECLARATION

I understand that this completed declaration must be kept in my records for three years from the

purchase date. I understand that failure to provide the declaration to Revenue auditors could

result in my liability for Sales Tax if the transaction is subsequently determined to be taxable.

Attached is Invoice No.

dated

covering this exempt transaction.

Vendor’s Signature

Form Rev-1715 - Exempt Organization Declaration Of Sales Tax Exemption