State of New Jersey
ST-4
(05-12, R-15)
DIVISION OF TAXATION
SALES TAX
PURCHASER’S NEW JERSEY
ELIGIBLE NONREGISTERED
*
**
TAXPAYER REGISTRATION NUMBER
PURCHASER: SEE INSTRUCTIONS
FORM ST-4
EXEMPT USE CERTIFICATE
To be completed by purchaser and given to and retained by seller.
Please read and comply with the instructions given on both sides of this certificate.
TO _________________________________________________________________________________ Date _______________________________
(Name of Seller)
________________________________________________________________________________________________________________________
Address
City
State
Zip
The undersigned certifies that there is no requirement to pay the New Jersey Sales and/or Use Tax on the purchase
or purchases covered by this Certificate because the tangible personal property or services purchased will be used for
an exempt purpose under the Sales & Use Tax Act.
The tangible personal property or services will be used for the following exempt purpose*:
The exemption on the sale of the tangible personal property or services to be used for the above described exempt
purpose is provided in subsection N.J.S.A. 54:32B-
(See reverse side for listing for principal exempt
uses of tangible personal property or services and fill in the block with proper subsection citation).
I, the undersigned purchaser, have read and complied with the instructions and rules promulgated pursuant to the New Jersey Sales and Use Tax
Act with respect to the use of the Exempt Use Certificate, and it is my belief that the seller named herein is not required to collect the sales or use
tax on the transaction or transactions covered by this Certificate. The undersigned purchaser hereby swears under the penalties for perjury and
false swearing that all of the information shown in this Certificate is true.
__________________________________________________________________________________________
*
NAME OF PURCHASER
(as registered with the New Jersey Division of Taxation)
__________________________________________________________________________________________
*
(Address of Purchaser)
__________________________________________________________________________________________
*
TYPE OF BUSINESS
By
__________________________________________________________________________________________
*
(Signature of owner, partner, officer of corporation, etc.)
(Title)
MAY BE REPRODUCED
*Required
(Front & Back Required)