E-595E — Streamlined Sales Tax Exemption Certificate

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Web-Fill 4-22 Streamlined Sales and Use Tax Certificate of Exemption E-595E Do not send this form to the Streamlined Sales Tax Governing Board or the NC Department of Revenue. Send the completed form to the seller and keep a copy for your records. This is a multi-state form for use in the states listed. Not all states allow all exemptions listed on this form. The purchaser is responsible for ensuring it is eligible for the exemption in the state it is claiming the tax exemption from. Check with the state for exemption information and requirements. The purchaser is liable for any tax and interest, and possible civil and criminal penalties imposed by the state, if the purchaser is not eligible to claim this exemption. Check if this certificate is for a single purchase. Enter the related invoice/purchase order #1 01 Accommodation and food services 02 Agricultural, forestry, fishing, and 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) Purchaser's type of business. Check the number that describes your business.3 A. Purchaser's name B. Business address City State Country Zip code D. Seller's address City State Country Zip code C. Name of seller from whom you are purchasing, leasing, or renting Please print H Agricultural production # I Industrial production/manufacturing # J Direct pay permit # K Direct mail # L Other (explain) A Federal government (department) B State or local government (name) C Tribal government (name) D Foreign diplomat # G Resale # Reason for exemption. Check the letter that identifies the reason for the exemption.4 Signature of authorized purchaser Print name here Title Date Sign and Date. I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.6 Phone number E-mail address Identification (ID) number. Enter the ID number as required in the instructions for each state in which you are claiming an exemption. If claiming multiple exemption reasons, enter the letters identifying each reason as listed in Section 4 for each state. ID Number State/Country Reason

AR GA IA IN KS KY MI MN NC ND NE NJ ID Number State/Country Reason

# NV OH OK RI SD TN UT VT WA WI WV WY

Sections 1-6 are required information. A signature is not required if in electronic form. The purchaser is liable for any tax and interest, and possible civil and criminal penalties imposed by the state, if the purchaser is not eligible to claim this exemption. Section 1: Check the box for a single purchase and enter the invoice/purchase order number. If the box is not checked, this certificate is considered a blanket certificate and remains effective until cancelled by the purchaser if purchases are no more than 12 months apart, unless a longer period is allowed by a state. In North Carolina, a recurring business relationship exists when a period of no more than 12 months elapses between sales transactions. Section 2: Enter the purchaser's and seller's name, street address, city, state, country, and zip code. Section 3 Type of Business: Check the number that best describes the purchaser's business or organization. If none of the categories apply, check 20 and provide a brief description. Section 4 Reason for Exemption: Check the letter that identifies the reason for the exemption. If the exemption you are claiming is not listed, check "L Other" and provide a clear and concise explanation of the exemption claimed. Not all states allow all exemptions listed on this form. The purchaser must check with that state for exemption information and requirements. Section 5 Identification ID Number: Enter the ID number as required in the instructions for each state in which you are claiming an exemption. Purchaser's Instructions: Enter the ID number as required in the instructions below for each state in which you are claiming an exemption. Identify the state or if a foreign ID, the country the ID number is from. If multiple exemption reasons are being claimed enter the letters identifying the reasons for exemption as listed in Section 4 for each state. ID Numbers for Exemptions other than resale: You are responsible for ensuring that you are eligible for the exemption in the state you are claiming the tax exemption. Provide the ID number to claim exemption from sales and use tax that is required by the taxing state. Check with that state to determine your exemption requirements and status. Foreign diplomats and consular personnel must enter their individual tax identification number shown on their sales tax exemption card issued by the United States Department of State's Office of Foreign Missions. ID Numbers for Resale Purchases (Including Drop Shipments): If you are claiming a purchase is not subject to tax because it is for resale (Exemption Reason G.) and you are: 1. Required to be registered in the state you are claiming the tax exemption: Provide your sales tax ID number issued by that state. If claiming exemption in OH and registration is not required in the state, enter any tax ID number issued by OH. If claiming exemption in MI and registration is not required in the state, enter "Not Required". 2. Not registered in the state you are claiming the tax exemption: Provide your sales tax ID number issued by any state. 3. Not required to register for sales tax and you do not have a sales tax identification number from any state: Enter -Your FEIN. -If you do not have a FEIN, enter a different state-issued business ID number. -If you do not have any state-issued business ID number or FEIN, enter your state driver's license number. 4. A foreign purchaser and you do not have an ID number described in 1, 2, or 3: The following states will accept the tax ID number (e.g., VAT number) issued by your country: AR, IN, KS, KY, ND, NJ, OK, RI, SD, TN, UT, WA, WY. All other states require an ID number as listed in 1, 2 or 3. If you do not have any of the ID numbers listed in 1 thru 4: You are not required to list an ID number for the following states: NE, OH, SD, WI. Enter "Not Required" and the reason for exemption for that state. All other states require an ID number. Seller's Instructions: The seller is not required to verify the purchaser's ID number or determine the purchaser's registration requirements. (GA requires the seller verify the purchaser's ID number.) The seller is required to maintain proper records of exempt transactions and provide those records to the state when requested in the form in which it is maintained. These certificates may be provided in paper or electronic format. If a paper exemption certificate is not forwarded by the purchaser, the seller must maintain the required data elements required on the form in an electronic format and make it available to Member states when requested. (see N.C. Gen. Stat. § 105-164.28) The seller is not liable for any tax, interest, or penalty if the purchaser improperly claims an exemption or provides incorrect information on the certificate, provided all the following conditions are met: 1. The fully completed exemption certificate or required data elements are provided to the seller at the time of sale or within 90 days subsequent to the date of sale (see N.C. Gen. Stat. § 105-164.28) 2. The seller did not fraudulently fail to collect the tax due; and 3. The seller did not solicit customers to unlawfully claim an exemption. Note: 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. Drop Shipper Instructions: The drop shipper may accept an ID number to claim the resale exemption as provided above in the Purchaser's Instructions. The ID number may include an ID number issued by another state. This may result in the same ID number being used for multiple states to claim the resale exemption (e.g., a retailer or marketplace seller may only be required to register for sales tax in one state). Section 6 Sign and Date: Sign and date the certificate of exemption. Print your name along with your title, phone number, and e-mail address where you can be reached if the Department has questions about your certificate of exemption. Certificate of Exemption Instructions Streamlined Sales and Use Tax E-595E Web-Fill 4-22