Form ST3 Minnesota Certificate of Exemption

1 Stock No. 2100030 (Rev. 12/03)ST3 Purchaser: Complete this Certificate and give it to the seller. Do not send to the Department of : Keep this Certificate as a part of your records. If this Certificate is not fully completed, you must charge oneSingle purchase certificateBlanket Certificate (if checked, this Certificate continues in force until cancelled by the purchaser)Name of purchaser s business or organizationBusiness addressCityStateZip codePurchaser s state tax ID numberState of issueIf no number, give reasonName of seller from whom you are purchasing, leasing or rentingSeller s addressCityStateZip codePrint or typeType of exemptionSignature of authorized purchaserPrint name herePhoneDate( )I declare that the information on this Certificate is correct and complete to the best of my knowledge and belief.

2 (PENALTY If youtry to evade paying sales tax by using an Exemption Certificate for items or services that will be used for purposes other than thosebeing claimed, you may be fined $100 under Minnesota law for each transaction for which the Certificate is used.)If you have questions, call 651-296-6181. TTY: Call 711 for Minnesota and fact sheets are available on our website at hereCircle the Exemption reason code. Enter the number or title where or industrial pay. Enter DP#CExempt organization.

3 Enter ES# or type of group DMotor carrier direct pay. Enter MCDP#EMultiple points of Exemption . Advertising (enter percentage) % Utilities (enter percentage) % recovery facility. Enter CN#IOther. Enter title Certificate of ExemptionDescribe the nature of your business or organization. Include a description of the items normally sold in your business,if the items for which you are claiming business/exempt items2 Exemption reason codesSee the descriptions on pages 3and 4 for more information aboutthe following Agricultural andindustrial productionMaterials and supplies used or consumedin agricultural or industrial productionof items intended to be sold ultimately atretail.

4 Does not cover machinery, tools(except qualifying detachable tools andspecial tooling), accessories, furniture andfixtures used to produce a Direct payDirect-pay number issued by Depart-ment of Revenue. Cannot be used formeals, lodging and most Exempt organizations Charitable (ES# required) Chore/homemaking services for elderlyand disabled Federal government Hospitals Libraries Nursing homes Outpatient surgical centers Religious and educational (churches,schools, school districts, scouts, youthgroups, etc.)

5 Senior citizen group (ES# required)D. Motor carrier direct payMotor carrier direct-pay number issuedby Department of Multiple points of useServices or electronically deliveredcomputer software that is made availablefor use in more than one taxing jurisdic-tion at the same Percentage exemptions Advertising materials for use outsideMinnesota or local taxing area. Utilities used in agricultural orindustrial ResaleItems or services purchased for Resource recovery facilityIssued CN number by Department Other exemptions Airflight equipment Ambulances Aquaculture production equipment Automatic fire-safety sprinkler systems Biosolids processing equipment Bullet-resistant body armor Emergency-vehicle accessories Emergency-rescue-vehicle repair Exempt publications Farm machinery Firefighter equipment Handicapped

6 Accessible (buildingmaterials) Handicapped accessible (vehicle costs) Horse materials Job opportunity building zones (JOBZ) Logging equipment Materials for business use in a statewhere no sales tax applies Materials used to provide taxableservices Medical supplies for a health-carefacility Packing materials used to ship house-hold goods outside Minnesota Poultry feed Prizes used for games at fairs or otherevents lasting fewer than six days Repair or replacement parts used inanother state/country as part of amaintenance contract Ship replacement parts and lubricants Ski area items State

7 Or local government agency fromanother state Taconite production items Telecommunications equipment Townships (gravel, machinery, andequipment used for road and bridgemaintenance) TV commercials Veteran organizations Waste-management containers andcompactors Wind energy systems3 Exemption descriptionsContinuedUse Form ST3, Exemption Certificate , toclaim the following exemptions. Fact sheetsare available for some of the items as our office for details about otherexemptions not listed or industrial and supplies used or consumed inagricultural or industrial production ofitems intended to be sold ultimately at not cover machinery, tools (exceptqualifying detachable tools and specialtooling), accessories, furniture and fixturesused to produce a product.

8 Fact Sheet 100,Agricultural production , or Fact Sheet 145,Industrial pay. Allows the buyer to pay salestax on certain items directly to the stateinstead of to the seller. Applicants must beregistered to collect sales tax in order toqualify and must apply for and receiveapproval and a DP# from the Departmentof Revenue. Enter the DP# on Form be agovernment or nonprofit organization asdescribed below. Cannot be used to buymeals and lodging exempt, except for thefederal government. Charitable organizations.

9 Must beoperated exclusively for charitablepurposes. You must apply for and receivean ES# from the Department of the number on Form ST3. (Somenonprofit organizations do not qualify forsales-tax Exemption .) Chore/homemaking servicespurchased by a local governmentspecifically for elderly and disabled. The federal government may providepurchaser orders, payment vouchers,work orders or complete Form ST3. Hospitals owned by a local governmentor that qualify as charitable under IRC501(c)(3) can use this Certificate withoutan Exemption number or may apply foran ES# from the Department of Revenue.

10 Public, county law,state agency, and the state and legislativelibraries. Nursing homes owned by a localgovernment or that qualify as charitableunder IRC 501 (c)(3) can use Form ST3without an Exemption number or mayapply for an ES# from the Department ofRevenue. Outpatient surgical centers thatqualify as charitable under IRC 501(c)(3)can use this Certificate without anexemption number or may apply for anES# from the Department of Revenue. Religious and educational , schools, school districts,scouts, youth groups, etc.