Form St: Ex-A1 - Application For Sales Tax Certificate Of Exemption

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ST: EX-A1
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LABAMA
EPARTMENT OF
EVENUE
9/04
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
Application for Sales Tax Certificate of Exemption
An Alabama Sales Tax Certificate of Exemption shall be used by persons, firms, or corporations coming under the provi-
sions of the Alabama Sales Tax Act who are not required to have a Sales Tax License.
PLEASE COMPLETE EACH LINE APPLICABLE TO YOUR BUSINESS. A SALES TAX CERTIFICATE OF EXEMP-
TION WILL NOT BE ISSUED UNTIL THIS APPLICATION IS PROPERLY COMPLETED.
1. Federal Employer Identification Number (FEIN) _______________________ 2. Business Telephone (______)_____________
3. ___________________________________________________________________________________________________________
NAME OF PERSON(S), FIRM, CORPORATION, ASSOCIATION, CO-PARTNERSHIP MAKING APPLICATION.
___________________________________________________________________________________________________________
GIVE TRADE NAME
4. Mailing address of home office________________________________________________________________________________
P. O. BOX OR STREET NO. OR R.F.D.
___________________________________________________________________________________________________________
CITY
COUNTY
STATE
ZIP CODE
5. Number of businesses in Alabama __________ Location __________________________________________________________
CITY
STREET AND NO. OF HWY.
COUNTY
Location must be exact street number or, if on highway or rural route, give details of location. If more than one location,
please attach schedule._______________________________________________________________________________________
6. Kind and Class of Business ___________________________________________________________________________________
WHOLESALER, MANUFACTURER, ETC.
7. Type Product Manufactured and/or sold _______________________________________________________________________
8. REASON EXEMPTION CLAIMED___________________________________________________________________________
___________________________________________________________________________________________________________
9. Form of ownership:
Individual
Partnership
Corporation
Multi member LLC
Single member LLC
Other ___________________________________________________
If applicant is a corporation, a copy of the certified certificate of incorporation, amended certificate of incorporation, cer-
tificate of authority, or articles of incorporation should be attached. If the applicant is a limited liability company or a lim-
ited liability partnership, a copy of the certified articles of organization should be attached.
10. Ownership information:
Corporations – give name, title, home address, and Social Security Number of each officer.
Partnerships/LLP’s – give name, home address, and Social Security Number or FEIN of each partner.
Sole Proprietorships – give name, home address, and Social Security Number of owner.
LLC – give name, home address, and Social Security Number or FEIN of each member.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Signed _______________________________________________
Signed _______________________________________________
Title __________________________ Date __________________
Title __________________________ Date __________________
MAIL ORIGINAL AND ONE COPY OF APPLICATION TO THE TAXPAYER SERVICE CENTER
LISTED ON THE REVERSE SIDE THAT SERVES THE COUNTY IN WHICH YOU ARE LOCATED.
REVENUE DEPARTMENT USE ONLY
Examiner’s Remarks ____________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
Examiner _____________________________________ Date ___________________
Supervisor’s Recommendation ___________________________________________________________________________________
_______________________________________________________________________________________________________________
Supervisor _____________________________________ Date ___________________

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