Rev. 3/15
Sales and Use Tax
Blanket Exemption Certicate
The purchaser hereby claims exception or exemption on all purchases of tangible personal property and selected services
made under this certi cate from:
(Vendor’s name)
and certies that the claim is based upon the purchaser’s proposed use of the items or services, the activity of the purchase,
or both, as shown hereon:
Purchaser must state a valid reason for claiming exception or exemption.
Purchaser’s name
Purchaser’s type of business
Street address
City, state, ZIP code
Signature Title
Date signed
Vendor’s license number, if any
Vendors of motor vehicles, titled watercraft and titled outboard motors may use this certicate to purchase these items
under the “resale” exception. Otherwise, purchaser must comply with either rule 5703-9-10 or 5703-9-25 of the Admin-
istrative Code.This certicate cannot be used by construction contractors to purchase material for incorporation into
real property under an exempt construction contract. Construction contractors must comply with rule 5703-9-14 of the
Administrative Code.
Reset Form