Form ST-105 |
Indiana Department of Revenue |
StateForm :19065 R'+/8-0-5 |
General SalesThx Exemption Certificate |
Indianaregisteredrelail merchantsand businesseslocatedoutsideIndianamay usethis certificate.The claimedexemptionmust be allowedby Indiana code. Exemption slatutesof other statesare not valid tbr purchasesfrom Indiana vendors.This exemption certilicate can not be issued for the purchase of lLili/iqg, Vehicles, Watercraft, or Ai/crafr. Pttrcha.sermust be registered with the Depafiment of Revenue or the appropriate taxing authorityofthe purchaser'sstateof residence.
Sales tax must be charged unless a!! information in each 6ection is fully completed by the purchaser. Purchasersnot able to provide all required informationmust pay the tax and may file a ctaim for refund(Form GA- I lol-) directly with the Departmentof Revenue.
Name of Purchaser
B u s i n e s s A d d r e s s |
C i t y |
P u r c h a s e rm u s t p r o v i d e m i n i m u m o f o n e I D n u n i b e r b e l c l w . t '
Provide your Indiana Registered Retail Merchant's Certificatc TID and LOC Number as shown on your Certificate .
If not registered with the Indiana DOR, provide your State Tax I D N u m b e r f r o m a n o t h e r S t a t e . . . . . .
*See instructions on the reverse side if vou do not have either number .
T I D # ( l 0 d i g i t s ) |
LOC# ( 3 digits) |
SrarelD# |
Stateof Issue |
HI s t h i s a I b l a n k e t p u r c h a s ee x e m p t i o n r e q u e s to r a I
D e s c r i p t i o no f i l e m s t o b e p u r c h a s e d .
s i n g l e p u r c h a s ee x e m p t i o n r e q u e s t ? ( c h e c k o n e )
Purchasermust indicatethe lype oI exemptionbeing claimedfor this purchase.(checkone or explain)
Salesto a retailer,wholesaler,or manufacturerfor resaleonly.
Saleof manufactu ng machinery tools.andequipmentto be useddirectly in direct production.
Salesto nonprofft organizations claimingexemptionpursuantto SalesTax lnformationBullelin #10. (May not be usedfor personalhotel roomsand meals.)
Salesofrangible personalpropertypredominatelyused(greaterthen50 percent)in providing public transportation - provide USDOT#.
Apersonor corporalionwho is baulingundersomeoneelse'smotor carrierauthority,or hasa contractasa schoolbus operator, must providc their SS#or FID# in lieu of a StateID# in Section#1. USDOT# -
Salesto persons,occupationallyengagedasfamers, to be useddirectly in productionof agricultural productsfor sale. Note: A farmernot possessinga StateBusinessLicense#may entera FID# or a SS# in lieu of a StateID# in Section#1.
Salesto a contractor for exemptprojects(suchaspublic $chools,or nonprofits). Sovemment,
Salesto Indiana Governmental Units (agencies,cilies,towns.municipalities,public schools,and slateuniversities).
Salesto the United States Federal Government - show agency name .
Note: A U . S . Government asencv should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID# .
E O t h e r - e x p l a i n .
Iherebycerlify underthe penaltiesof perjury that lhe propeny purchasedby the useof this exemptioncertificateis to be usedfor an exempt purposepursuanlto theStateCrossRetailSalesTaxAct, IndianaCode6-2.5,andthe item purchasedis not a utility, vehicle,watercraft,or aircraft.
Iconfirm my undeBtandingthat misuse,(?ifrer egligentor intentioral), and/orfraudulentuseofthis certificatemay subjectboth me personally and/orthe businessentity I represenlto the impositionoftax, interest,and civil and/orcriminal penalties.
Signature of Purchaser |
Date |
Printed Name |
Title |
The Indiana Dcpartntent of Revenue may request verification of registration in another state if you are an out - of - state purchaser .
Seller must keep this certificate on file to support exempt sales.
For.mST-105
GeneralInfonnation and Instructions
All four (4) sectionsof theST-I 05 mustbecompletedor the exemptionis not valid andtheselleris responsible for thecollectionof theIndianasalestax.
A)This sectionrequires an identification number. In mostcasesthis numberwill be anIndiana DeparunentofRevenueissuedTaxpayerldentificationNumber(TID# - seenotebelow) usedfor Indianasalesand/orwithholdingtax reporting. If the purchaseris from anotherstateanddoei not possessanIndianaTID#, a residentstate'sbusinesslicense,or StateissuedID# mustbeprovided.
B)Exceptions- For a purchasernot possessingeitheranIndianaTID# or anotherStateID#, thefollowing
may beusedin lieu of thisrequirement. tr'ederalGovernment- placeyourFID# in theStateID# space. Farmer - placeyour SS#or FID# in theStateID# space.
Public transportation haulersoperatingunderanothermotor carrierauthority,or witb a contractasa
schoolbusoperator,mustindicatetheir SS#or FID# in theStateID# space. Nonprolit Organization- mustshowits FID# in the StateID# space.
A)Check a box to indicateif this is a singlepurchaseor blanketexemption.
B)Describeproductbeingpurchased.
A)Purchasermustcheckthereasonfor exemption.
B)Purchasermustbe ableto provide additionalinformation if requested.
A)Purchasermust sign and date the form.
B)Printednameandtitle of signermustbe shown.
Note: The Indiana TlrxpayerIdentification Number (TID#) is a ten (10) digit number followed by a thtee (3) digit LOC#. The TID# is alsoknown asthe following:
a)RegisteredRetail Merchant Certificat€
b)Tax Exempt Identification Number
c)SalesTax Identification Number
d)Withholding Tax Identification Number
The RegisteredRetailMerchantCertificateissuedby the IndianaDepartrnentofRevenueshows the TID# ( I 0 digits) and the LOC# (3 digits) at the top right of the certificate'