Form Cert-140 - Solar Heating Systems, Solar Electricity Generating Systems, And Ice Storage Cooling Systems Page 2
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1
2Name of Purchaser
Address
CT Tax Registration Number
Federal Employer ID #
(If applicable)
(If applicable)
Name of Seller
Address
CT Tax Registration Number
Federal Employer ID #
(If none, explain.)
Check one box:
Blanket certificate for purchase of tangible personal property described below
Certificate for one purchase only of tangible personal property or services described below
Check the appropriate box(es) and provide a written description of each item purchased:
Solar energy electricity generating systems;
Passive solar water or space heating systems;
Active solar water or space heating systems;
Geothermal resource systems;
Equipment related to any of the systems above;
Services described in Conn. Gen. Stat. §12-407(a)(37)(I) relating to the installation of any of the systems above;
Ice storage systems used for cooling;
Equipment related to ice storage cooling systems; or
Services described in Conn. Gen. Stat. §12-407(a)(37)(I) relating to the installation of ice storage cooling systems.
Description
Provide the address where systems and related equipment purchased with this certificate are intended to be used, if available.
Provide the address where services related to the installation of systems described above purchased with this certificate will be performed. This must
be completed if services related to the installation of the systems are purchased.
Street Address: _______________________________________________________________________________________________________
City, State, ZIP Code: _________________________________________________________________________________________________
Declaration by Purchaser
The item(s) described above qualify for exemption under
2007 Conn. Pub. Acts 242,
§68.
Declaration: I declare under penalty of law that I have examined this return or document (including any accompanying schedules and
statements) and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a
false return or document to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Name of Purchaser
By:
Authorized Signature of Property Owner, Tenant, or Contractor
Title
Date
CERT-140 (New 07/07)
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