Form 51a149 - Certificate Of Exemption For Pollution Control Facilities printable pdf download

Form 51a149 - Certificate Of Exemption For Pollution Control Facilities

51A149 (1-07)

Commonwealth of Kentucky

CERTIFICATE OF EXEMPTION

Important—Certificate

DEPARTMENT OF REVENUE

not valid unless completed.

FOR

POLLUTION CONTROL FACILITIES

This certificate may be executed only for those purchases of tangible personal property which qualify for exemption under

KRS 139.480(12). The certificate may be executed by either: (1) A holder of a Pollution Control Tax Exemption Certificate

or (2) jointly by a contractor and the holder of a Pollution Control Tax Exemption Certificate in any case in which a contractor

under contract with the certificate holder does, in fact, purchase such property.

THE UNDERSIGNED HEREBY CERTIFIES: That the materials and equipment to be purchased from

_________________________________________________________________________________________________

Name of Vendor

_________________________________________________________________________________________________

Address

will become a part of a pollution control facility at _________________________________________________________

Location of Facility

for which the Department of Revenue, as provided by KRS Chapter 224, has issued a Pollution Control Tax Exemption

Certificate. The undersigned agrees that in the event it is determined that any of the property described below is not tax-

exempt, the undersigned will immediately report and pay the required tax measured by the purchase price of the property.

Cost of property to be purchased: _______________________________________________________________________

Description of property to be purchased: _________________________________________________________________

_________________________________________________________________________________________________

Name of Contractor Under Contract with Holder of

Name of Holder of

Pollution Control Tax Exemption Certificate

Permit Account Number

Pollution Control Tax Exemption Certificate Number

Signature

Title

Signature

Title

Date

Address

CAUTION: A seller of tangible personal property accepting certificates shall be relieved from the sales and use tax only if

he maintains a file of these certificates for a period of not less than four years as provided by KRS 139.720.

Form 51a149 - Certificate Of Exemption For Pollution Control Facilities