Form Dr-97 - Suggested Format For An Exemption Certificate Based On Property'S Use printable pdf download

DR-97

Suggested Format for an Exemption

R. 12/17

Certificate Based on Property’s Use

This is to certify that the tangible personal property purchased, leased, licensed, or rented; or services purchased on

or after_______________(date) from _________________________________________(selling dealer’s business name) is

purchased, leased, licensed, or rented for the following purpose as checked in the space provided below.

Note: This is not intended to be an exhaustive list.

Materials, containers, labels, sacks, bags, or similar

Educational materials, such as glue, paper, paints,

items intended to accompany a product for sale at

crayons, unique craft items, scissors, books, and

other than retail, as provided in section (s.)

educational toys, purchased by child care facilities

212.02(14)(c), Florida Statutes (F.S.), by persons who

outlined in s. 402.305, F.S., that hold a current license

are not required to be registered under

under s. 402.308, F.S., hold a current Gold Seal

s. 212.18(3), F.S.

Quality Care designation as provided in s. 402.281,

F.S., and provide all employees with basic health

Incorporation into items of tangible personal property

insurance as defined in s. 627.6699(12), F.S., as

manufactured, produced, compounded, processed,

provided in s. 212.08(5)(m), F.S.

or fabricated for one’s own use, as provided in Rule

12A-1.043, Florida Administrative Code (F.A.C.).

Motor vehicle rented or leased by a dealer who will

provide the motor vehicle at no charge to a person

Printing of a publication exempt under the provisions

whose motor vehicle is being repaired, adjusted, or

of s. 212.08(7)(w), F.S.

serviced by the dealer, as provided in

Items, such as paper and ink, that will be

s. 212.0601(4), F.S.

incorporated into and become a component part of a

publication exempt under the provisions of

s. 212.08(7)(w), F.S.

Other (include description and statutory citation):

____________________________________________________________________________________________________________

Note: There are other suggested formats for exemption certificates based on the use of the property or services that

are provided in other sections of Rule Chapter 12A-1, F.A.C., and in Tax Information Publications (TIPs) issued by the

Department.

I understand that if I use the property or service for any nonexempt purpose, I must pay tax on the purchase or

lease price of the taxable property or service directly to the Department of Revenue.

I understand that if I fraudulently issue this certificate to evade the payment of sales tax, I will be liable for

payment of the sales tax plus a penalty of 200 percent of the tax and may be subject to conviction of a third

degree felony.

The exemption specified by the purchaser may be verified by calling 850-488-6800.

Purchaser’s name: ______________________________________________________________________________________

Purchaser’s address: _____________________________________________________________________________________

Name and title of purchaser’s authorized representative: ______________________________________________________

By: _____________________________________________________________________________________________________

(Signature of purchaser or authorized representative)

Title: _______________________________________________________________ Date: _____________________________

(Title – only if purchased by an authorized representative of a business entity)

Reference: Rule 12A-1.038, F.A.C.

Form Dr-97 - Suggested Format For An Exemption Certificate Based On Property'S Use

Related Articles

Related forms

Related Categories