Form
5060
Missouri Department of Revenue
Project Exemption Certificate
Taxation Division Phone: (573) 751-2836
P.O Box 358 Fax: (573) 522-1271
Jefferson City, MO 65105-0358 E-mail: salestaxexemptions@dor.mo.gov
Visit http://dor.mo.gov/business/sales/sales-use-exemptions.php for additional information.
Form 5060 (Revised 08-2015)
Name of Exempt Entity Issuing the Certificate Missouri Tax Exemption Number
Address City State ZIP Code
E-mail Address
Project Number Project Begin Date (MM/DD/YYYY) Estimated Project End Date (MM/DD/YYYY)
Description of Project
Project Location Certificate Expiration Date (MM/DD/YYYY)
Signature of Authorized Exempt Entity Printed Name of Authorized Exempt Entity Date (MM/DD/YYYY)
Provide a signed copy of this certificate, along with a copy of the exempt entity’s Missouri Sales and Use Tax Exemption
Letter to each contractor or subcontractor who will be purchasing tangible personal property for use in this project. It is the
responsibility of the exempt entity to ensure the validity of the information on the certificate. The exempt entity must issue a new
certificate if any of the information changes.
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Exempt Entity and Project Information
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This form is to be completed and given to your contractor.
The Missouri exempt entity named above hereby authorizes the purchase, without sales tax, of tangible personal property to be
incorporated or consumed in the construction project identified herein and no other, pursuant to Section 144.062, RSMo. Under
penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Contractor
Name of Purchasing Contractor Signature of Contractor Date (MM/DD/YYYY)
Address City State ZIP Code
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Name of Purchasing Subcontractor
Address City State ZIP Code
Signature of Contractor Contractor’s Printed Name Date (MM/DD/YYYY)
Subcontractor
Contractors - Present this to your supplier in order to purchase the necessary materials tax exempt. Complete the Subcontractor
portion if extending the certificate to your subcontractor. The contractor must sign the form in the space provided below.
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