Fillable Form ST-105: General Sales Tax Exemption Certicate

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Form ST-105: General Sales Tax Exemption Certicate

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Indiana Department of Revenue
General Sales Tax Exemption Certicate
Indiana registered retail merchants and businesses located outside Indiana may use this certicate. The claimed exemption must be
allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certicate
can not be issued for the purchase of Utilities, Vehicles, Watercraft, or Aircraft. Purchaser must be registered with the Department
of Revenue or the appropriate taxing authority of the purchaser’s state of residence.
Sales tax must be charged unless all information in each section is fully completed by the purchaser. Purchasers not able to provide
all required information must pay the tax and may le a claim for refund (Form GA-110L) directly with the Department of Revenue. A valid
certicate also serves as an exemption certicate for (1) county innkeeper’s tax and (2) local food and beverage tax.
Name of Purchaser:
_______________________________________________________________________________________
Business Address: _______________________ City: ___________________ State: _________ ZIP Code: ____________
Purchaser must provide minimum of one ID number below.*
Provide your Indiana Registered Retail Merchant’s Certicate TID and LOC Number as shown on your Certicate.
TID Number (10 digits): ___________________________ - LOC Number (3 digits): _______________
If not registered with the Indiana DOR, provide your State Tax ID Number from another State
*See instructions on the reverse side if you do not have either number.
State ID Number: _________________________ State of Issue: _________________
Is this a □ blanket purchase exemption request or a □ single purchase exemption request? (check one)
Description of items to be purchased: _________________________________________________________________________
Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain)
□ Sales to a retailer, wholesaler, or manufacturer for resale only.
□ Sale of manufacturing machinery, tools, and equipment to be used directly in direct production.
□ Sales to nonprot organizations claiming exemption pursuant to Sales Tax Information Bulletin #10. (May not be used for
personal hotel rooms and meals.)
□ Sales of tangible personal property predominately used (greater then 50 percent) in providing public transportation - provide
USDOT Number. A person or corporation who is hauling under someone else’s motor carrier authority, or has a contract as a
school bus operator, must provide their SSN or FID Number in lieu of a State ID Number in Section 1.
USDOT Number: ______________________
□ Sales to persons, occupationally engaged as farmers, to be used directly in production of agricultural products for sale.
Note: A farmer not possessing a State Business License Number may enter a FID Number or a SSN in lieu of a State ID
Number in Section 1.
□ Sales to a contractor for exempt projects (such as public schools, government, or nonprots).
□ Sales to Indiana Governmental Units (agencies, cities, towns, municipalities, public schools, and state universities).
□ Sales to the United States Federal Government - show agency name. __________________________________________
Note: A U.S. Government agency should enter its Federal Identication Number (FID) in Section 1 in lieu of a State ID
Number.
□ Other - explain. _______________________________________________________________________________________
I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certicate is to be used for
an exempt purpose pursuant to the State Gross Retail Sales Tax Act, Indiana Code 6-2.5, and the item purchased is not a utility,
vehicle, watercraft, or aircraft.
I conrm my understanding that misuse, (either negligent or intentional), and/or fraudulent use of this certicate may subject both
me personally and/or the business entity I represent to the imposition of tax, interest, and civil and/or criminal penalties.
Signature of Purchaser: _____________________________________________ Date: ______________________________
Printed Name: ____________________________________________________ Title: _______________________________
The Indiana Department of Revenue may request verication of registration in another state if you are an out-of-state purchaser.
Seller must keep this certicate on le to support exempt sales.
Form ST-105
State Form 49065
(R5 / 6-17)
Section 1 (print only)Section 2
Section 3
Section 4
Instructions for Completing Form ST-105
All four sections of the ST-105 must be completed or the exemption is not valid and the seller is responsible for the collection of the
Indiana sales tax.
Section 1
A) This section requires an identication number. In most cases this number will be an Indiana Department of Revenue issued
Taxpayer Identication Number (TID - see note below) used for Indiana sales and/or withholding tax reporting. If the purchaser is
from another state and does not possess an Indiana TID Number, a resident state’s business license, or State issued ID Number
must be provided.
B) Exceptions - For a purchaser not possessing either an Indiana TID Number or another State ID Number, the following may be
used in lieu of this requirement.
Federal Government – place your FID Number in the State ID Number space.
Farmer – place your SSN or FID Number in the State ID Number space.
Public transportation haulers operating under another motor carrier authority, or with a contract as a school bus operator, must
indicate their SSN or FID Number in the State ID Number space.
Nonprot Organization – must show its FID Number in the State ID Number space.
Section 2
A) Check a box to indicate if this is a single purchase or blanket exemption.
B) Describe product being purchased.
Section 3
A) Purchaser must check the reason for exemption.
B) Purchaser must be able to provide additional information if requested.
Section 4
A) Purchaser must sign and date the form.
B) Printed name and title of signer must be shown.
Note: The Indiana Taxpayer Identication Number (TID) is a ten digit number followed by a three digit LOC Number. The TID is also
known as the following:
a) Registered Retail Merchant Certicate
b) Tax Exempt Identication Number
c) Sales Tax Identication Number
d) Withholding Tax Identication Number
The Registered Retail Merchant Certicate issued by the Indiana Department of Revenue shows the TID (10 digits) and the LOC (3
digits) at the top right of the certicate.
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Form ST-105: General Sales Tax Exemption Certicate

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Completed 2 May 2021

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