Form St-28m - Multi-Jurisdiction Exemption Certificate - 2008
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1KANSAS DEPARTMENT OF REVENUE
MULTI-JURISDICTION EXEMPTION CERTIFICATE
NOTE: Check applicable state laws for authority to issue this certificate for the uses indicated below. Review
national tax reporting service publications for information about the states that honor this certificate.
Purchaser
_______________________________________________________________________________________________________________________
:
Business Name
Address:
_________________________________________________________________________________________________________________________
Street, RR, or P. O. Box
City
State
ZIP + 4
I hereby certify that I am a:
o
Wholesaler of: ______________________________________________________________________________________________
Description of principal product(s)
__________________________________________________________________________________________________
o
Retailer of:
Description of principal product(s)
o
____________________________________________________________________________________________
Manufacturer of:
Description of principal product(s)
o
Lessor of:
_____________________________________________________________________________________________________________________
Description of principal product(s)
o
______________________________________________________________________________________________________
Other:
Description of principal product(s)
and am registered* in the following cities or states:
Registration Number ________________________________
City or State_____________________________________________
Registration Number ________________________________
City or State_____________________________________________
* Wholesalers are not required to register with the Kansas Department of Revenue to collect sales tax unless they make retail sales. Retail sales include
sales to employees.
The tangible personal property described below which I am purchasing from:
Seller
: ____________________________________________________________________________________________________________________________
Business Name
Address:
_________________________________________________________________________________________________________________________
Street, RR, or P.O. Box
City
State
ZIP + 4
will be for wholesale, resale, or as ingredient or component parts of a new product to be resold, leased, or rented in the
normal course of my business.
Description of property purchased with this exemption certificate: _________________________________________
______________________________________________________________________________________________________________
I further certify that if the property purchased with this certificate is used or consumed so as to make it subject to sales or
use tax, I will pay the tax due directly to the proper taxing authority or inform the seller to add tax to the billing. This certificate
shall be a part of each order that I may give you in the future and is valid until canceled by me in writing or revoked by the
city or state.
Under the penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material
matter.
Authorized Signature: _________________________________________________________________
Date:_____________________
Misuse of this certificate by the seller, lessor, buyer, lessee, or their representative may be punishable by fine,
imprisonment, or loss of the right to issue certificates in some cities or states.
CAUTION TO THE SELLER: In order for this certificate to be accepted in good faith, you must exercise care that the property being sold is of a type
normally sold wholesale, resold, leased, rented, or used as an ingredient or component part of a product manufactured by the buyer in the usual
course of his business. A seller who fails to exercise due care and good judgment in this regard could be held liable for the sales tax due.
ST-28M (Rev. 7-08)
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