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MINNESOTAit REVENUE <br />Certificate of/ Exemption <br />Purchaser: Complete this certificate and give it to the seller. vy OF ORONO <br />Seller: If this certificate is not fully completed, you must charge sales tax. Keep this certificate as pbf your records. <br />ST3 <br />This is a blanket certificate, unless one of the boxes below is checked, and remains in force as long as the purchaser continues making <br />purchases, or until otherwise cancelled by the purchaser. <br />Ll Check if this certificate is for a single purchase and enter the related invoice/purchase order # <br />If you are a contractor and have a purchasing agent agreement with an exempt organization, check the box to make multiple <br />❑ <br />purchases for a specific job. Enter the exempt entity name and specific project: <br />Exempt entity name Project description <br />Name of purchaser <br />business address City State Zip code <br />LL Purchaser's tax ID number State of issue Country of issue <br />S � a —Oct< <br />z � f1 <br />If no tax ID number, FEIN Driver's license number/State issued ID number <br />enter one of the following: state of issue number <br />Name of seller from whom you are purchasing, (easing or renting <br />Seller's address City State Zip code <br />)2 ID y pL��(�)CLi C.t,yS <br />Type of business. Circle the number that describes your business. <br />01 Accommodation and food services <br />02 Agricultural, forestry, fishing, hunting <br />03 Construction <br />04 Finance and insurance <br />05 Information, publishing and communications <br />06 Manufacturing <br />07 Mining <br />08 Real estate <br />09 Rental and leasing <br />10 >Retail trade <br />11 <br />12 <br />13 <br />14 <br />15 <br />16 <br />17 <br />18 <br />19 <br />20 <br />Transportation and warehousing <br />Uties <br />Wholesale trade <br />Business services <br />Professional services <br />Education and health-care services <br />Nonprofit organization <br />Government <br />Not a business (explain) <br />Other (explain) <br />Reason for exemption. Circle the letter that identifies the reason for the exemption. <br />A Federal government (department) I Agricultural production <br />B Specific government exemption (from list on back) J Industrial production/manufacturing <br />K Direct pay authorization <br />C Tribal government (name) L (vi;ti�iilPJ3eXel�ipti0�l;s n�o>ara�ali�r:. ,.:user <br />D Foreign diplomat # softv.reptaledrMarch.4,92008 <br />E Charitable organization # M Direct mail <br />F Educational organization # N Other (enter number from back page) <br />G Religious organization # 0 Percentage exemption <br />H Resale ❑ Advertising (enter percentage) IYC <br />❑ Utilities (enter percentage) i,A % c <br />1 declare that the information on this certificate is correct and complete to the best of my knowledge and belief. (PENALTY• If you try <br />to evade paying sales tax by using an exemption certificate for items or services that will be used for purposes other than those being <br />claimed, you may be fined $100 under Minnesota law for each transaction for which the certificate is used.) <br />rnnc name new <br />Stock No. 2100030 (Rev. 11/10) Forms and fact sheets are available on our website at www.taxes.state.mn.us <br />