Account Application, Form Tc-721 - Exemption Certificate (Page 3 of 4) in pdf

Utah State Tax Commission

TC-721

Exemption Certificate

Rev. 6/11

(Sales, Use, Tourism and Motor Vehicle Rental Tax)

Name of business or institution claiming exemption (purchaser)

Telephone Number

Street Address

City

State

ZIP Code

Authorized Signature

Name (please print)

Title

Date

Name of Seller or Supplier:

The person signing this certificate MUST check the applicable box showing the basis for which the exemption is being claimed.

Questions should be directed (preferably in writing) to Taxpayer Services, Utah State Tax Commission, 210 N 1950 W, Salt Lake City, UT 84134.

Telephone (801) 297-2200, or toll free 1-800-662-4335.

DO NOT SEND THIS CERTIFICATE TO THE TAX COMMISSION

Keep it with your records in case of an audit.

For purchases by government, Native American tribes and public schools, use form TC-721G.

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RESALE OR RE-LEASE

MEDICAL EQUIPMENT

Sales Tax License No. ___ _ __ _ _ _ _ __ _ _ _ _

I certify the equipment or device checked below is prescribed by a

licensed physician for human use.

I certify I am a dealer in tangible personal property or services that

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are for resale or re-lease. If I use or consume any tangible personal

Durable Medical Equipment primarily used to serve a medical

property or services I purchase tax free for resale, or if my sales are

purpose, is not worn in or on the body, and is for home use

of food, beverages, dairy products and similar confections

only. (Sales of spas and saunas are taxable.)

dispensed from vending machines (see Rule R865-19S-74), I will

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Mobility Enhancing Equipment primarily used to improve

report and pay sales tax directly to the Tax Commission on my next

movement, is for use in a home or motor vehicle, and is not

sales and use tax return.

used by persons with normal mobility.

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LEASEBACKS

Prosthetic Device used to replace a missing body part, to prevent

or correct a physical deformity, or support a weak body part. This

I certify the tangible personal property leased satisfies the following

conditions: (1) the property is part of a sale-leaseback transaction; (2)

is also exempt if purchased by a hospital or medical facility.

sales or use tax was paid on the initial purchase of the property; and,

(Sales of corrective eyeglasses and contact lenses are taxable.)

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(3) the leased property will be capitalized and the lease payments will

Disposable Home Medical Equipment or Supplies that

be accounted for as payments made under a financing arrangement.

cannot withstand repeated use and purchased by, for, or on

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behalf of a person other than a health care facility, health care

AGRICULTURAL PRODUCER

provider or office of a health care provider. The equipment

I certify the items purchased will be used primarily and directly in a

and supplies must be eligible for payment under Title XVIII,

commercial farming operation and qualify for the Utah sales and use

federal Social Security Act, or the state plan for medical

tax exemption.

assistance under Title XIX, federal Social Security Act.

❑

COMMERCIAL AIRLINES

❑

OUT-OF-STATE CONSTRUCTION MATERIALS

I certify the food and beverages purchased are by a commercial

I certify this tangible personal property will be shipped out of state

airline for in-flight consumption; or, any parts or equipment

and will become part of real property located in a state that does not

purchased are for use in aircraft operated by common carriers in

have a sales tax or allow credit for tax paid to Utah.

interstate or foreign commerce.

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CONSTRUCTION MATERIALS PURCHASED FOR AIRPORTS

COMMERCIALS, FILMS, AUDIO AND VIDEO TAPES

I certify the construction materials are purchased by, on behalf of, or

Sales Tax License No. ___ _ _ __ _ _ _ _ _ __ _ _

for the benefit of Salt Lake International Airport, or a new airport

I certify that purchases of commercials, films, prerecorded video

owned or operated by a city in Davis, Utah, Washington or Weber

tapes, prerecorded audio program tapes or records are for sale or

County. I further certify the construction materials will be installed or

distribution to motion picture exhibitors, or commercial television or

converted into real property owned by and located at the airport.

radio broadcasters. If I subsequently resell items to any other

❑

customer, or use or consume any of these items, I will report any tax

CONSTRUCTION MATERIALS PURCHASED FOR RELIGIOUS

liability directly to the Tax Commission.

AND CHARITABLE ORGANIZATIONS

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I certify the construction materials purchased are on behalf of a

FILM, TELEVISION, VIDEO

religious or charitable organization. I further certify the purchased

I certify that purchases, leases or rentals of machinery or equip-

construction materials will be installed or converted into real

ment will be used by a motion picture or video production company

property owned by the religious or charitable organization.

for the production of media for commercial distribution.

Name of religious or charitable organization:

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POLLUTION CONTROL FACILITY

__ __ __ ___ __ ___ __ __________ _ _ _ _ _ _

Sales Tax License No. __________________________

Sales Tax Exemption No. _____________________________

I certify our company has been granted a “Certification of Pollution

Name of project: _ __ __ ___ __ __ ___ _ _ _ _ _ _ _ _

Control Facilities” as provided for by Utah Code §§19-2-123 through

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19-2-127 and as explained in Tax Commission Rule R865-19S-83

DIRECT MAIL

by either the Air Quality Board or the Water Quality Board. I further

Sales Tax License No. ___ __ __ ___ __ _ _ _ _

certify each item of tangible personal property purchased under this

I certify I will report and pay the sales tax for direct mail purchases

exemption is qualifying machinery or equipment for this purpose.

on my next Utah Sales and Use Tax Return.

Account Application, Form Tc-721 - Exemption Certificate Page 3

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