Sales Tax Exemption Certificate Multi - Jurisdiction
DR 0563 (08/30/13) COLORADO DEPARTMENT OF REVENUE Denver CO 80261-0013
*130563==19999*
Sales Tax Exemption Certificate Multi - Jurisdiction See page 2 for instructions Last Name or Business Name
First Name
Middle Initial
Address City
State
ZIP
State
ZIP
I Certify That
Name of Firm (Buyer) Address City
Qualifies As (Check each applicable item) Retailer Manufacturer
Wholesaler
Political Subdivision or Governmental Agency
Charitable or Religious
Other (Specify)
If Other, specify here
1) and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is
or
2) that such purchases are exempt from payment of sales or use tax in such states and cities because our buyer is: Political Subdivision or Governmental Agency
Charitable or Religious
Otherwise Exempt By Statute (Specify)
If Otherwise Exempt By Statue, specify here City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
If the list of states and cities is more than six(6), attach a list to this certificate. I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sale or Use Tax we will pay the tax due direct to proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and shall be called until canceled by us in writing or revoked by the city or state. General Description of products to be purchased from seller
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature (owner, Partner or Corporate Officer)
Title
Date (MM/DD/YY)
To Our Customers: In order to comply with the majority of state and local sales tax law requirements, it is necessary that we have in our files a properly executed exemption certificate from all of our customers who claim sales tax exemption. If we do not have this certificate, we are obligated to collect the tax for the state in which the property is delivered. If you are entitled to sales tax exemption, please complete the certificate and send it to us at your earliest convenience. If you purchase tax free for a reason for which this form does not provide, please send us your special certificate or statement. *Lessor: A form DR0440, “Permit to Collect Sales Tax on the Rental or Lease Basis” must be completed and submitted to the Department of Revenue for approval.
Caution To Seller: In order for the certificate to be accepted in good faith by the seller, the seller must exercise care that the property being sold is of a type normally sold wholesale, resold, leased, rented , or utilized as an ingredient or component part of a product manufactured by the buyer in the usual course of his business. A seller failing to exercise due care could be held liable for the sales tax due in some states or cities. Misuse of this certificate by the seller, lessor, buyer, lessee, or the representative thereof may be punished by fine, imprisonment or loss of right to issue certificates in some states or cities.
Return to Issuing Hotel/Motel Revised – July 1, 2009
Affidavit of Exemption from City of Colorado Springs Sales Tax The City of Colorado Springs Sales Tax Division requires that this affidavit must be completed by any organization requesting exemption from City Sales or Lodgers Tax at local hotels or motels. If an organization does not complete this form, exemption will not be granted. If you have any question about this affidavit, please contact the Sales Tax Division at (719) 385-5903. Name of Organization: Address: Yes No [ ] [ ] State tax exempt?
State of
Category: Charitable Name of Hotel:
State Exemption Number Religious
Government
Not-for-Profit School
Date(s) of meeting:
Please answer the following questions and return this affidavit to the hotel or motel. All questions must be answered “Yes” for the purchase to qualify as exempt. Yes No [ ] [ ] Is the organization a governmental entity, a not-for-profit school, a qualified religious organization, or a qualified charitable organization? (In order for a religious or charitable organization to be qualified, the organization must be classified as 501(c) (3) under the Internal Revenue Code, and the organization must be described in Section 170(c) of the Internal Revenue Code of 1986, i.e., donations to this organization are deductible on the Federal Income Tax Return of the donor. If you do not know absolutely that the organization is a 501(c) (3) and 170(c), or cannot prove it, the organization does not qualify, and this question must be answered “No”.) Yes No [ ] [ ] Is this purchase billed directly to the organization and paid for directly by the organization from funds of the organization? Purchases by governmental employees using cash, personal checks or credit cards issued to individuals are not direct purchases by the government and are not tax exempt. Proof of payment with organization funds is required. Yes No [ ] [ ] If payment is made by credit card, is the credit card issued to the tax-exempt organization making the purchase and not N/A the individual presenting the card? (In order for this question to be answered “Yes”, the monthly statement of the credit [ ] card company must be mailed directly to and paid directly by the tax-exempt organization and not the individual, and the individual presenting the card must have no responsibility or liability for payment of the credit card bill. Proof of payment with organization funds is required.
The undersigned declares and affirms that the above questions are answered truthfully, that he/she has sufficient knowledge about the purchase to answer the questions completely, and that the purchase is made for use by the organization in its exempt capacity. Name (Please Print)
Signature
Reviewed by Hotel/Motel:
Title
Date
Date
Note: The hotel should keep this affidavit on file as proof of exemption, along with proof of payment with organization funds documentation.
Instructions for Use of Affidavits These instructions are applicable for both the Charitable or Religious Affidavit and the Governmental Affidavit. Both of the affidavits require that the goods are sold directly to the charitable, religious or governmental agency and payment is made directly from those organization’s funds. Please be sure this is the case before asking for completion of the appropriate affidavit. This affidavit is intended to assist the vendor in maintaining documentation that will be needed to verify whether a transaction is exempt. The sale is not exempt from taxes simply because this affidavit is completed. The responsibility for proper collection of the taxes remains with the vendor. The ordinance provides that if the vendor and purchaser disagree on the application of the tax, the vendor must collect the tax. The vendor should give the purchaser a receipt showing the taxes collected. The purchaser then has 60 days to file a claim for refund directly with the City for recovery of the tax. The claim for refund form can be obtained from the Treasury web site. The affidavits need to be completed in their entirety. Be sure information is complete, accurate and legible. Review the information being sure the Driver’s License Number and customer’s name are correct. Also the digits that are required from the credit cards are correct. Only record and keep those digits from the credit card that the affidavit requires. The signature of the customer should be the same as on the driver’s license. Charitable organizations must include a copy of the letter provided to them by the City stating they may make purchases without payment of the tax. Churches usually will not have a letter. The Church may be exempt upon accurate completion of the Charitable or Religious Affidavit. For purchases by the federal government using a credit card please see City and County of Denver Tax Guide Topic 91 entitled “Credit Cards from Governmental Organizations”. It explains which of the credit cards can be used for purchases of tangible personal property. It also explains how the numbering system can be used to identify if the federal government is paying for the purchase (not taxable) or the individual is paying for the purchase (taxable).
11/10
AFFIDAVIT OF SALE PAID BY GOVERNMENT CREDIT CARD I affirm that this purchase qualifies for the Denver and Colorado sales tax exemption for sales to the United States government, the State of Colorado, its departments and institutions, and its political subdivisions (county and local governments, school districts and special districts); is a government purchase used only in an official governmental capacity; and will be paid directly by a government agency. I have checked the applicable boxes below regarding information about payment for this purchase.
I accept that I remain directly liable for the sales or use tax assessment, and any applicable penalty or interest, if my purchase is found to not qualify for the exemption. I understand that the vendor may request this affidavit for every purchase. Please Print or Type Customer Name
Driver License Number (include state)
Agency Name
Colorado Tax ID Number or FEIN
Customer Address
Agency Phone
City
State
ZIP Code
Check All that Apply FEDERAL GOVERNMENT PURCHASES: Credit card used is a GSA Smart Pay2 card and is designated as such on the face of the card. Credit card used is a Fleet card, outlined in green, with a picture of a road and a flag. Credit card used is a Purchase card, outlined in red, with a picture of a keyboard and a flag. Credit card used is a Travel card, outlined in blue, with a picture of an airplane and a flag, and the 6th digit on the credit card is 0, 6, 7, 8, or 9. Credit card used is an Integrated card, outlined in gold, with a picture of an eagle and a flag. Credit card is issued to an agency within the Department of the Interior. STATE AND LOCAL GOVERNMENT PURCHASES:
For State of Colorado cards, the agency exemption number is printed on the card. The # is 98The card states "For Official State Use Only" or "Tax Exempt." The card is a Purchasing Card and is designated as such on the card. FOREIGN AND DIPLOMATIC EXEMPTION CARDS
The card is State Department issued with the name/photo of the bearer and a blue, yellow, red, green, or red/green band across the bottom, and states on the face of the card what purchases qualify for exemption. It does not matter what form of payment is used when these cards are presented.
Signature of Customer
11/10
Date
*130563==19999*
Sales Tax Exemption Certificate Multi - Jurisdiction See page 2 for instructions Last Name or Business Name
First Name
Middle Initial
Address City
State
ZIP
State
ZIP
I Certify That
Name of Firm (Buyer) Address City
Qualifies As (Check each applicable item) Retailer Manufacturer
Wholesaler
Political Subdivision or Governmental Agency
Charitable or Religious
Other (Specify)
If Other, specify here
1) and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is
or
2) that such purchases are exempt from payment of sales or use tax in such states and cities because our buyer is: Political Subdivision or Governmental Agency
Charitable or Religious
Otherwise Exempt By Statute (Specify)
If Otherwise Exempt By Statue, specify here City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
City or State
State Registration or ID Number
If the list of states and cities is more than six(6), attach a list to this certificate. I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sale or Use Tax we will pay the tax due direct to proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and shall be called until canceled by us in writing or revoked by the city or state. General Description of products to be purchased from seller
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature (owner, Partner or Corporate Officer)
Title
Date (MM/DD/YY)
To Our Customers: In order to comply with the majority of state and local sales tax law requirements, it is necessary that we have in our files a properly executed exemption certificate from all of our customers who claim sales tax exemption. If we do not have this certificate, we are obligated to collect the tax for the state in which the property is delivered. If you are entitled to sales tax exemption, please complete the certificate and send it to us at your earliest convenience. If you purchase tax free for a reason for which this form does not provide, please send us your special certificate or statement. *Lessor: A form DR0440, “Permit to Collect Sales Tax on the Rental or Lease Basis” must be completed and submitted to the Department of Revenue for approval.
Caution To Seller: In order for the certificate to be accepted in good faith by the seller, the seller must exercise care that the property being sold is of a type normally sold wholesale, resold, leased, rented , or utilized as an ingredient or component part of a product manufactured by the buyer in the usual course of his business. A seller failing to exercise due care could be held liable for the sales tax due in some states or cities. Misuse of this certificate by the seller, lessor, buyer, lessee, or the representative thereof may be punished by fine, imprisonment or loss of right to issue certificates in some states or cities.
Return to Issuing Hotel/Motel Revised – July 1, 2009
Affidavit of Exemption from City of Colorado Springs Sales Tax The City of Colorado Springs Sales Tax Division requires that this affidavit must be completed by any organization requesting exemption from City Sales or Lodgers Tax at local hotels or motels. If an organization does not complete this form, exemption will not be granted. If you have any question about this affidavit, please contact the Sales Tax Division at (719) 385-5903. Name of Organization: Address: Yes No [ ] [ ] State tax exempt?
State of
Category: Charitable Name of Hotel:
State Exemption Number Religious
Government
Not-for-Profit School
Date(s) of meeting:
Please answer the following questions and return this affidavit to the hotel or motel. All questions must be answered “Yes” for the purchase to qualify as exempt. Yes No [ ] [ ] Is the organization a governmental entity, a not-for-profit school, a qualified religious organization, or a qualified charitable organization? (In order for a religious or charitable organization to be qualified, the organization must be classified as 501(c) (3) under the Internal Revenue Code, and the organization must be described in Section 170(c) of the Internal Revenue Code of 1986, i.e., donations to this organization are deductible on the Federal Income Tax Return of the donor. If you do not know absolutely that the organization is a 501(c) (3) and 170(c), or cannot prove it, the organization does not qualify, and this question must be answered “No”.) Yes No [ ] [ ] Is this purchase billed directly to the organization and paid for directly by the organization from funds of the organization? Purchases by governmental employees using cash, personal checks or credit cards issued to individuals are not direct purchases by the government and are not tax exempt. Proof of payment with organization funds is required. Yes No [ ] [ ] If payment is made by credit card, is the credit card issued to the tax-exempt organization making the purchase and not N/A the individual presenting the card? (In order for this question to be answered “Yes”, the monthly statement of the credit [ ] card company must be mailed directly to and paid directly by the tax-exempt organization and not the individual, and the individual presenting the card must have no responsibility or liability for payment of the credit card bill. Proof of payment with organization funds is required.
The undersigned declares and affirms that the above questions are answered truthfully, that he/she has sufficient knowledge about the purchase to answer the questions completely, and that the purchase is made for use by the organization in its exempt capacity. Name (Please Print)
Signature
Reviewed by Hotel/Motel:
Title
Date
Date
Note: The hotel should keep this affidavit on file as proof of exemption, along with proof of payment with organization funds documentation.
Instructions for Use of Affidavits These instructions are applicable for both the Charitable or Religious Affidavit and the Governmental Affidavit. Both of the affidavits require that the goods are sold directly to the charitable, religious or governmental agency and payment is made directly from those organization’s funds. Please be sure this is the case before asking for completion of the appropriate affidavit. This affidavit is intended to assist the vendor in maintaining documentation that will be needed to verify whether a transaction is exempt. The sale is not exempt from taxes simply because this affidavit is completed. The responsibility for proper collection of the taxes remains with the vendor. The ordinance provides that if the vendor and purchaser disagree on the application of the tax, the vendor must collect the tax. The vendor should give the purchaser a receipt showing the taxes collected. The purchaser then has 60 days to file a claim for refund directly with the City for recovery of the tax. The claim for refund form can be obtained from the Treasury web site. The affidavits need to be completed in their entirety. Be sure information is complete, accurate and legible. Review the information being sure the Driver’s License Number and customer’s name are correct. Also the digits that are required from the credit cards are correct. Only record and keep those digits from the credit card that the affidavit requires. The signature of the customer should be the same as on the driver’s license. Charitable organizations must include a copy of the letter provided to them by the City stating they may make purchases without payment of the tax. Churches usually will not have a letter. The Church may be exempt upon accurate completion of the Charitable or Religious Affidavit. For purchases by the federal government using a credit card please see City and County of Denver Tax Guide Topic 91 entitled “Credit Cards from Governmental Organizations”. It explains which of the credit cards can be used for purchases of tangible personal property. It also explains how the numbering system can be used to identify if the federal government is paying for the purchase (not taxable) or the individual is paying for the purchase (taxable).
11/10
AFFIDAVIT OF SALE PAID BY GOVERNMENT CREDIT CARD I affirm that this purchase qualifies for the Denver and Colorado sales tax exemption for sales to the United States government, the State of Colorado, its departments and institutions, and its political subdivisions (county and local governments, school districts and special districts); is a government purchase used only in an official governmental capacity; and will be paid directly by a government agency. I have checked the applicable boxes below regarding information about payment for this purchase.
I accept that I remain directly liable for the sales or use tax assessment, and any applicable penalty or interest, if my purchase is found to not qualify for the exemption. I understand that the vendor may request this affidavit for every purchase. Please Print or Type Customer Name
Driver License Number (include state)
Agency Name
Colorado Tax ID Number or FEIN
Customer Address
Agency Phone
City
State
ZIP Code
Check All that Apply FEDERAL GOVERNMENT PURCHASES: Credit card used is a GSA Smart Pay2 card and is designated as such on the face of the card. Credit card used is a Fleet card, outlined in green, with a picture of a road and a flag. Credit card used is a Purchase card, outlined in red, with a picture of a keyboard and a flag. Credit card used is a Travel card, outlined in blue, with a picture of an airplane and a flag, and the 6th digit on the credit card is 0, 6, 7, 8, or 9. Credit card used is an Integrated card, outlined in gold, with a picture of an eagle and a flag. Credit card is issued to an agency within the Department of the Interior. STATE AND LOCAL GOVERNMENT PURCHASES:
For State of Colorado cards, the agency exemption number is printed on the card. The # is 98The card states "For Official State Use Only" or "Tax Exempt." The card is a Purchasing Card and is designated as such on the card. FOREIGN AND DIPLOMATIC EXEMPTION CARDS
The card is State Department issued with the name/photo of the bearer and a blue, yellow, red, green, or red/green band across the bottom, and states on the face of the card what purchases qualify for exemption. It does not matter what form of payment is used when these cards are presented.
Signature of Customer
11/10
Date
