Tax Exempt Sale Affidavit (Page 2 of 4) in pdf

Tax Exempt Sale Affidavit Page 2

AFFIDAVIT OF SALE

Made to a Charitable or Religious Organization

• I affirm this purchase qualifies for the City of Pueblo sales tax exemption as a purchase to a

charitable or religious organization and will be paid directly by the charitable or religious

organization only used in their charitable or religious capacity. And is not a reimbursed expense.

• I affirm personal funds are not being used to pay for the purchase.

• I have included a copy of the license issued by the City of Pueblo that indicates this organization

is recognized as a charitable organization.

• I accept that I remain directly liable for the sales or use tax assessment, and any applicable

penalty or interest, if my purchase is found not to qualify for the exemption.

• I understand that the vendor may request this affidavit for every purchase.

Customer Name:

Driver License Number (include state)

Organization’s Name:

City of Pueblo ID #

Customer Address:

Organization’s Phone #:

City

State

Zip Code

The purchase is paid by a check drawn on funds of the exempt organization or is direct billed to the

exempt organization based upon an issued purchase order.

The purchase is paid for with a company purchasing card in the name of the exempt organization. The

embossed name on the card is _____________________________________.

The card is a commercial card and not a personal credit card. The embossed name on the card is

__________________________________. Last four digits are _ _ _ _.

Payment made in CASH, PERSONAL CREDIT OR DEBIT CARD, PERSONAL CHECKING

ACCOUNT OR GIFT CARD does not qualify as exempt from City of Pueblo Sales Tax .

Transaction is only exempt if payment method clearly states organization’s name.

I, hereby certify, under penalty of perjury, that the statements made herein are to the best of my knowledge true and

correct.

Signature of Customer

PHONE

Date

If a vendor and purchaser disagree on the application of a tax, the vendor must collect the tax. The

vendor will provide the purchaser with a receipt showing how much sales tax was collected on the

purchase. The purchaser may submit a claim for refund to the City of Pueblo. The claim for refund

form is available at , click on “City Departments” then on “Sales Tax”.

Tax Exempt Sale Affidavit Page 2