Indiana Department of Revenue
General Sales Tax Exemption Certicate
Indiana registered retail merchants and businesses located outside Indiana may use this certicate. The claimed exemption must be
allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certicate
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
certicate also serves as an exemption certicate 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 Certicate TID and LOC Number as shown on your Certicate.
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 nonprot 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 nonprots).
□ 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 Identication Number (FID) in Section 1 in lieu of a State ID
□ Other - explain. _______________________________________________________________________________________
I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certicate 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 conrm my understanding that misuse, (either negligent or intentional), and/or fraudulent use of this certicate 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 verication of registration in another state if you are an out-of-state purchaser.
Seller must keep this certicate on le to support exempt sales.
State Form 49065
(R5 / 6-17)
Section 1 (print only)Section 2