Streamlined Sales Tax Agreement
Certificate of Exemption
Do not send this form to the Streamlined Sales Tax Governing Board. Send
the completed form to your supplier and keep a copy for your records.
This is a multi-state 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 st
ate 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 possible 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.
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 here Title Date
Print or type
Circle type of business
Circle or check reason
for exemption
Sign
here
Purchaser’s Type of business. Circle the number that best describes your business.
01 Accommodation and food services
02 Agriculture, forestry, fishing, hunting
03 Construction
04 Finance and insurance
05 Information, publishing and communications
06 Manufacturing
07 Mining
08 Real estate
09 Rental and leasing
10 Retail trade
11 Transportation and warehousing
12 Utilities
13 Wholesale trade
14 Business services
15 Professional services
16 Education and health-care services
17 Nonprofit organization
18 Government
19 Not a business
20 Other (explain)
A. Name of purchaser
B. Business address City State Zip code
C. Purchaser’s tax ID number State of Issue Country of Issue
D. If no tax ID number, enter one of the following: FEIN
E. Driver ’s License Number/State Issued ID number
F. Foreign diplomat number
G. Name of seller from whom you are purchasing, leasing or renting
H. Seller’s address Zip code
H Agricultural Production #
I Industrial production/manufacturing #
J Direct pay permit #
K Direct Mail #
L Other (Explain)
Reason for exemption. Circle the letter that identifies the reason for the exemption.
A Federal government (Department)
B State or local government (Name)
C
Tribal government (Name)
D
Foreign diplomat #
E
Charitable organization #
F
Religious organization #
G
Resale #
Check if you are attaching the Multistate Supplemental form.
If not, enter the two-letter abbreviation for the state under whose laws you are claiming exemption.
Check if this certificate is for a Single Purchase Certif
icate. Enter the related invoice/purchase order # _______________.
1.
3.
4.
5.
6.
2.
City State
State of Issue
M Educational Organization #
SSTGB Form F0003 Exemption Certificate (Revised 5/10/2017 for use 1/1/2018)
