Get SSTGB F0003 2018-2023

I declare that the information on this certificate is correct and complete to the best of my knowledge and belief. Signature of Authorized Purchaser Print Name Title Date SSTGB Form F0003 Exemption Certificate 1/1/2018 Multi-state Supplemental STATE Identification Number If Required AR GA IA IN KS KY MI MN NC ND NE NJ NV OH OK RI SD TN UT VT WA WI WV WY SSUTA Direct Mail provisions are not in effect for Tennessee. Streamlined Sales and Use Tax Agreement Certificate of Exemption This is a multistate form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide this exemption certificate or the data elements required on the form to a state that would otherwise be due tax on this sale. The purchaser will be held liable for any tax and interest and possibly civil and criminal penalties imposed by the member state if the purchaser is not eligible to claim this exemption* A seller may not accept a certificate of exemption for an entity-based exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption* Check if you are attaching the Multistate Supplemental form* If not enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption* Check if this certificate is for a single purchase and enter the related invoice/purchase order Please Print Name of Purchaser Business Address City State Purchaser s Tax ID Number If no Tax ID Number State of Issue 1 FEIN 2 Driver s License Number or State Issued ID Number Enter one of the following Country of Issue 3 Foreign Diplomat Number No* Zip code Accommodation and food services Agricultural forestry fishing hunting Construction Finance and insurance Information publishing and communications Manufacturing Mining Real estate Rental and leasing Retail trade Transportation and warehousing Utilities Wholesale trade Business services Professional services Education and health-care services Nonprofit organization Government Not a business Other explain Reason for exemption* Circle the letter that identifies the reason for the exemption* A B C D E F G Type of business. Circle the number that describes your business Name of seller from whom you are purchasing leasing or renting Seller s address. Federal government department State or local government name Tribal government name Charitable organization Religious organization Resale H I J K L M Industrial production/manufacturing Direct pay permit Direct mail Educational organization Sign here. The following nonmember states will accept this certificate for exemption claims that are valid in their respective state. The seller may be required to provide this exemption certificate or the data elements required on the form to a state that would otherwise be due tax on this sale. The purchaser will be held liable for any tax and interest and possibly civil and criminal penalties imposed by the member state if the purchaser is not eligible to claim this exemption* A seller may not accept a certificate of exemption for an entity-based exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption* Check if you are attaching the Multistate Supplemental form* If not enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption* Check if this certificate is for a single purchase and enter the related invoice/purchase order Please Print Name of Purchaser Business Address City State Purchaser s Tax ID Number If no Tax ID Number State of Issue 1 FEIN 2 Driver s License Number or State Issued ID Number Enter one of the following Country of Issue 3 Foreign Diplomat Number No* Zip code Accommodation and food services Agricultural forestry fishing hunting Construction Finance and insurance Information publishing and communications Manufacturing Mining Real estate Rental and leasing Retail trade Transportation and warehousing Utilities Wholesale trade Business services Professional services Education and health-care services Nonprofit organization Government Not a business Other explain Reason for exemption* Circle the letter that identifies the reason for the exemption* A B C D E F G Type of business. .