Form ST-105 State Form 49065 R4/ 8-05 Indiana Department of Revenue General Sales Tax Exemption Certificate Indiana registered retail merchants and businesses located outside Indiana may use this certificate. The claimed exemption must be allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certificate can not be issued for the purchase of Utilities, Vehicles, Watercraft, or Aircraft. Purchaser must be registered with the Department of Revenue or the appropriate taxing authority of the purchaser’s state of residence. Sales tax must be charged unless all information in each section is fully completed by the purchaser. Purchasers not able to provide all required information must pay the tax and may file a claim for refund (Form GA-110L) directly with the Department of Revenue. Section 2 Section 1 (print only) Name of Purchaser Business Address City State Zip Purchaser must provide minimum of one ID number below.* Provide your Indiana Registered Retail Merchant’s Certificate TID and LOC Number as shown on your Certificate............................... TID# (10 digits) If not registered with the Indiana DOR, provide your State Tax ID Number from another State................................................................ *See instructions on the reverse side if you do not have either number. Is this a blanket purchase exemption request or a - LOC# ( 3 digits) State ID# State of Issue single purchase exemption request? (check one) Description of items to be purchased. Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain) Sales to a retailer, wholesaler, or manufacturer for resale only. Sale of manufacturing machinery, tools, and equipment to be used directly in direct production. Section 3 Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin #10. (May not be used for personal hotel rooms and meals.) Sales of tangible personal property predominately used (greater then 50 percent) in providing public transportation - provide USDOT#. A person or corporation who is hauling under someone else’s motor carrier authority, or has a contract as a school bus operator, must provide their SS# or FID# in lieu of a State ID# in Section #1. USDOT# Sales to persons, occupationally engaged as farmers, to be used directly in production of agricultural products for sale. Note: A farmer not possessing a State Business License# may enter a FID# or a SS# in lieu of a State ID# in Section #1. Sales to a contractor for exempt projects (such as public schools, government, or nonprofits). Sales to Indiana Governmental Units (agencies, cities, towns, municipalities, public schools, and state universities). Sales to the United States Federal Government - show agency name. Note: A U.S. Government agency should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID#. Other - explain. Section 4 I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt purpose pursuant to the State Gross Retail Sales Tax Act, Indiana Code 6-2.5, and the item purchased is not a utility, vehicle, watercraft, or aircraft. I confirm my understanding that misuse, (either negligent or intentional), and/or fraudulent use of this certificate may subject both me personally and/or the business entity I represent to the imposition of tax, interest, and civil and/or criminal penalties. Signature of Purchaser Date Printed Name Title The Indiana Department 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. American LegalNet, Inc. www.FormsWorkflow.com Form ST-105 General Information and Instructions All four (4) sections of the ST-105 must be completed or the exemption is not valid and the seller is responsible for the collection of the Indiana sales tax. Section 1 Instructions A) This section requires an identification number. In most cases this number will be an Indiana Department of Revenue issued Taxpayer Identification Number (TID# - see note below) used for Indiana sales and/or withholding tax reporting. If the purchaser is from another state and does not possess an Indiana TID#, a resident state’s business license, or State issued ID# must be provided. B) Exceptions - For a purchaser not possessing either an Indiana TID# or another State ID#, the following may be used in lieu of this requirement. Federal Government – place your FID# in the State ID# space. Farmer – place your SS# or FID# in the State ID# space. Public transportation haulers operating under another motor carrier authority, or with a contract as a school bus operator, must indicate their SS# or FID# in the State ID# space. Nonprofit Organization – must show its FID# in the State ID# space. Section 2 Instructions A) Check a box to indicate if this is a single purchase or blanket exemption. B) Describe product being purchased. Section 3 Instructions A) Purchaser must check the reason for exemption. B) Purchaser must be able to provide additional information if requested. Section 4 Instructions A) Purchaser must sign and date the form. B) Printed name and title of signer must be shown. Note: The Indiana Taxpayer Identification Number (TID#) is a ten (10) digit number followed by a three (3) digit LOC#. The TID# is also known as the following: a) Registered Retail Merchant Certificate b) Tax Exempt Identification Number c) Sales Tax Identification Number d) Withholding Tax Identification Number The Registered Retail Merchant Certificate issued by the Indiana Department of Revenue shows the TID# (10 digits) and the LOC# (3 digits) at the top right of the certificate. American LegalNet, Inc. www.FormsWorkflow.com