Application For Qualifying Farmer Exemption Certificate Number printable pdf download

Application For Qualifying Farmer Exemption Certificate Number

E-595QF

Application for Qualifying Farmer

Web

Exemption Certificate Number

6-14

Office Use

for Qualified Purchases

North Carolina Department of Revenue

A “qualifying farmer” is a farmer who has an annual gross income for the preceding income tax year of ten thousand dollars

($10,000) or more from farming operations or who has an average annual gross income for the three preceding income tax

years of ten thousand dollars ($10,000) or more from farming operations. A qualifying farmer includes a dairy operator, a

poultry farmer, an egg producer, a livestock farmer, a farmer of crops, and a farmer of an aquatic species, as defined in N.C.

Gen. Stat. § 106-758.

If Corporation, Partnership, or LLC

If Proprietorship enter

Social Security Number:

Federal Employer ID No.:

enter

Type of Ownership:

Proprietorship

Corporation

Partnership

LLC

Other (Identify)

Applicant’s Legal Name:

Trade Name (DBA Name):

Street Address:

Street

(Not P.O. Box Number)

City

State

Zip Code

Mailing Address:

Street or P.O. Box

City

State

Zip Code

Enter agricultural exemption certificate number issued to applicant prior to July 1, 2014, if applicable.

Applicant engages in the following farming operations. (Fill in all applicable circles)

Dairy operator

Livestock farmer

Poultry farmer

Farmer of crops

Egg producer

Farmer of an aquatic species as defined in N.C. Gen. Stat. § 106-758

Enter the annual gross income for the preceding income tax year from farming operations or the average annual gross

income for the three preceding income tax years from farming operations. Provide gross income documentation (tax

returns) with this application in order for the Department to substantiate annual or average gross income from farming

operations. Failure to attach documentation will delay processing of the application for a qualifying farmer exemption

certificate number.

Preceding Year

Average for Three Preceding Years

Signature:

Date:

I certify that this application is accurate and complete.

Name (Print):

Title:

E-mail:

Phone:

Mail to: N.C. Department of Revenue, Registration Unit

P. O. Box 25000, Raleigh, NC 27640-0001

Application For Qualifying Farmer Exemption Certificate Number

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