Form 13 - Nebraska Resale Or Exempt Sale Certificate For Sales Tax Exemption

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Nebraska Resale or Exempt Sale Certificate
FORM
13
for Sales Tax Exemption
RESET FORM
• Read instructions on reverse side/see note below
NAME AND MAILING ADDRESS OF PURCHASER
NAME AND MAILING ADDRESS OF SELLER
Name
Name
O'REILLY AUTO ENTERPRISES, LLC
Street or Other Mailing Address
Street or Other Mailing Address
PO BOX 1156
City
State
Zip Code
City
State
Zip Code
65801
SPRINGFIELD
MO
Check Type of Certificate
If blanket is checked, this certificate is valid until revoked in writing by the purchaser.
Single Purchase
Blanket
I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason:
Purchase for Resale (Complete Section A)
Exempt Purchase (Complete Section B)
Contractor (Complete Section C)
Check One
SECTION A — Nebraska Resale Certificate
Description of Item or Service Purchased
I hereby certify that the purchase, lease, or rental of
from the above seller is exempt from the Nebraska sales tax as a purchase for resale, rental, or lease in the normal course of our business, either in the
form or condition in which purchased, or as an ingredient or component part of other property to be resold.
I further certify that we are engaged in business as a:
Wholesaler
Retailer
Manufacturer
Lessor
of
Description of Product Sold, Leased, or Rented
If None, State Reason
01-
and hold Nebraska Sales Tax Permit Number
or Foreign State Sales Tax Number
State
SECTION B — Nebraska Exempt Sale Certificate
The basis for this exemption is exemption category
(Insert appropriate category as described on reverse of this form.)
If exemption category 2 or 5 is claimed, enter the following information:
Intended Use of Item(s) Purchased
Description of Item(s) Purchased
If exemption categories 3 or 4 are claimed, enter the Nebraska Exemption Certificate number.
05 -
If exemption category 6 is claimed, seller must enter the following information and sign this form below:
Description of Item(s) Sold
Date of Seller’s Original Purchase
Was Tax Paid when Purchased by Seller?
Was Item Depreciable?
YES
NO
YES
NO
SECTION C — For Contractors Only
1. purchases of building materials or fixtures:
As an Option 1 or Option 3 contractor, I hereby certify that purchases of building materials and fixtures from the above seller are exempt from
Nebraska sales tax. My Nebraska Sales or Consumer’s Use Tax Permit Number is:
01-
2. purchases made under purchasing agent appointment on behalf of _________________________________________________:
(exempt entity)
Pursuant to an attached Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17, I hereby certify that purchases
of building materials, and fixtures are exempt from Nebraska sales tax.
Any purchaser, or their agent, or other person who completes this certificate for any purchase which is other than for resale, lease, or rental in the
regular course of the purchaser’s business, or is not otherwise exempted from the sales and use tax under Neb. Rev. Stat. §§77-2701 through 77-27,135,
shall in addition to any tax, interest, or penalty otherwise imposed, be subject to a penalty of $100 or ten times the tax, whichever amount is larger, for
each instance of presentation and misuse. With regard to a blanket certificate, this penalty shall apply to each purchase made during the period the blanket
certificate is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct
and complete.
sign
here
Authorized Signature
Title
Date
NOTE: Sellers must keep this certificate as part of their records. Do not SenD to the nebRaSka DepaRtment of Revenue.
Incomplete certificates cannot be accepted.
, (800) 742-7474 (toll free in ne and Ia), (402) 471-5729
3-2009
6-134-1970 Rev.
Supersedes 6-134-1970 Rev. 10-2007

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