Form ST-105 Indiana Department of Revenue State Form ...

1 Form ST-105 Indiana Department of Revenue StateForm :19065 R'+/8-0-5 general SalesThx exemption certificate Indianaregisteredrelail merchantsand businesses locatedoutsideIndianamay usethis claimedexemptionmust be allowedby Indiana code. exemption slatutesof other statesare not valid tbr purchasesfrom Indiana exemption certilicate can not be issued for the purchase of lLili/iqg, Vehicles, Watercraft, or Ai/crafr. 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 .

2 Name of Purchaser Business Address City State _ Zip 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 . TID# ( l0 digits) LOC# ( 3 digits). If not registered with the Indiana DOR, provide your State Tax ID Number from *See instructions on the reverse side if vou do not have either number. SrarelD# Stateof Issue H Is this 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.

3 (checkone or explain). E Salesto a retailer,wholesaler,or manufacturerfor resale only. E Saleof manufactu ng machinery tools. and equipmentto be useddirectly in direct production. E Salesto nonprofft organizations claiming exemptionpursuantto SalesTax lnformation Bullelin #10. (May not be usedfor personalhotel rooms and meals.). E Salesofrangible personalpropertypredominatelyused(greate rthen50 percent)in providing public transportation - provide USDOT#. A personor corporalionwho is bauling undersomeoneelse'smotor carrierauthority,or has a contractas a school bus operator, must providc their SS#or FID# in lieu of a StateID# in Section#1. USDOT# - E Salesto persons,occupationallyengagedas famers, to be useddirectly in productionof agricultural productsfor sale.

4 Note: A farmer not possessinga StateBusinessLicense#may entera FID# or a SS# in lieu of a StateID# in Section#1. E Salesto a contractor for exemptprojects(suchas public $chools,Sovemment,or nonprofits). E Salesto Indiana Governmental Units (agencies,cilies, towns. municipalities,public schools,and slateuniversities). El Sales to the United states Federal Government - show agency name. Note: A Government asencv should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID#. E Other - explain. I herebycerlify under the penaltiesof perjury that lhe propeny purchasedby the use of this exemptioncertificateis to be used for an exempt purposepursuanlto the StateCrossRetail SalesTax Act, ,and the item purchasedis not a utility, vehicle,watercraft,or aircraft.

5 I confirm 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. general Infonnation and Instructions All four (4) sectionsof the ST-I 05 mustbe completedor the exemptionis not valid andthe seller is responsible for thecollection of the Indianasalestax. A) This sectionrequires an identification number. In mostcasesthis numberwill be an Indiana DeparunentofRevenueissuedTaxpayerldentif icationNumber(TID# - seenotebelow) usedfor Indianasalesand/orwithholdingtax reporting.

6 If the purchaseris from anotherstateanddoei not possess anIndianaTID#, a residentstate'sbusiness license,or StateissuedID# mustbe provided. - B) Exceptions For a purchaser not possessing either an IndianaTID# or anotherStateID#, the following may be usedin lieu of this requirement. tr'ederalGovernment- placeyour FID# in the StateID# space. Farmer - placeyour SS#or FID# in theStateID# space. Public transportation haulers operatingunderanothermotor carrierauthority,or witb a contractasa schoolbusoperator,mustindicatetheir SS#or FID# in the StateID# space. Nonprolit Organization - mustshowits FID# in the StateID# space. A) Check a box to indicateif this is a singlepurchaseor blanketexemption. B) Describeproductbeing purchased.

7 A) Purchasermust checkthe reasonfor exemption . B) Purchasermust be able to provide additionalinformation if requested. A) Purchasermust sign and date the form. B) Printed nameand title of signermust be shown. Note: The Indiana Tlrxpayer Identification Number (TID#) is a ten (10) digit number followed by a thtee (3). digit LOC#. The TID# is alsoknown as the following: a) Registered Retail Merchant Certificat . b) Tax Exempt Identification Number c) SalesTax Identification Number d) Withholding Tax Identification Number The RegisteredRetail MerchantCertificateissuedby the Indiana DepartrnentofRevenueshows the TID# ( I 0 digits) and the LOC# (3 digits) at the top right of the certificate '.