Fillable Form Tc-721 - Exemption Certificate printable pdf download

Utah State Tax Commission • 210 N 1950 W • Salt Lake City, UT 84137

Print Form

TC-721

Exemption Certificate

Rev. 7/15

Clear form

(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 signer of this certificate MUST check the box showing the basis for which the exemption is being claimed.

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.

❑

RESALE OR RE-LEASE

MUNICIPAL ENERGY

Sales Tax License No. ____ ___ _____ ____

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

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

I certify the natural gas or electricity purchased: is for resale; is

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

prohibited from taxation by federal law, the U.S. Constitution, or the

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

Utah Constitution; is for use in compounding or producing taxable

of food, beverages, dairy products and similar confections

energy; is subject to tax under the Motor and Special Fuel Tax Act;

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

is used for a purpose other than as a fuel; is used by an entity

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

exempted by municipal ordinance; or is for use outside a municipal-

sales and use tax return.

ity imposing a municipal energy sales and use tax. The normal

sales tax exemptions under Utah Code §59-12-104 do not apply to

❑

LEASEBACKS

the Municipal Energy Sales and Use Tax.

I certify the tangible personal property leased satisfies the following

❑

POLLUTION CONTROL FACILITY

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

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

Sales Tax License No. __________________________

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

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

be accounted for as payments made under a financing arrangement.

Control Facilities” as provided for by Utah Code §§19-12-101 -

❑

19-12-305 by either the Air Quality Board or the Water Quality

COMMERCIAL AIRLINES

Board. I further certify each item of tangible personal property

Sales Tax License No. ____ ____ _____ ___

purchased under this exemption is qualifying.

I certify the food and beverages purchased are by a commercial

❑

MEDICAL EQUIPMENT

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

purchased are for use in aircraft operated by common carriers in

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

interstate or foreign commerce.

licensed physician for human use.

❑

Durable Medical Equipment primarily used to serve a medical

COMMERCIALS, FILMS, AUDIO AND VIDEO TAPES

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

Sales Tax License No. ____ ____ _____ ___

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

❑

I certify that purchases of commercials, films, prerecorded video

Mobility Enhancing Equipment primarily used to improve

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

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

distribution to motion picture exhibitors, or commercial television or

used by persons with normal mobility.

radio broadcasters. If I subsequently resell items to any other

❑

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

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

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

liability directly to the Tax Commission.

❑

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

FILM, TELEVISION, VIDEO

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

❑

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

Disposable Home Medical Equipment or Supplies that

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

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

for the production of media for commercial distribution.

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

❑

provider or office of a health care provider. The equipment

ALTERNATIVE ENERGY

and supplies must be eligible for payment under Title XVIII,

Sales Tax License No. ____ ____ _____ ___

federal Social Security Act, or the state plan for medical

I certify the tangible personal property meets the requirements of Utah

assistance under Title XIX, federal Social Security Act.

Code §59-12-104 and is leased or purchased by or for an alternative

❑

energy electricity production facility, a waste energy production facility,

RELIGIOUS OR CHARITABLE INSTITUTION

or a facility that produces fuel from alternative energy.

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

❑

I certify the tangible personal property or services purchased will be

FUELS, GAS, ELECTRICITY

used or consumed for essential religious or charitable purposes.

Sales Tax License No. ____ ____ _____ ___

This exemption can only be used on purchases totaling $1,000

I certify all natural gas, electricity, coal, coke, and other fuel

or more, unless the sale is pursuant to a contract between the

purchased will be used for industrial use only and not for residential

seller and purchaser.

or commercial purposes.

❑

DIRECT MAIL

STEEL MILL

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

Sales Tax License No. ____ ____ _____ ___

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

I certify the rolls, rollers, refractory brick, electric motors or other

on my next Utah Sales and Use Tax Return.

replacement parts will be used in the furnaces, mills or ovens of a steel

mill as described in Standard Industrial Classification (SIC) 3312.

IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.

Clear form

Form Tc-721 - Exemption Certificate

Related Articles

Related forms

Related Categories