60 2010 5000 AZ Form 0
User Manual: 5000
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Arizona Department of Revenue
Transaction Privilege Tax Exemption Certifi cate
ADOR 60-2010 (12/04)
Reason for Exemption - check as applicable
1. Tangible personal property to be resold in the ordinary course of business.
2. Tangible personal property to be leased or rented in the ordinary course of business.
3. Tangible personal property to be incorporated into a taxable contracting project.
4. Food, drink, or condiments purchased by a restaurant business.
5. Motor vehicle fuel and use fuel subject to tax under ARS § 28-5606 or 5708.
6. Use fuel to a holder of a valid single trip use fuel tax permit issued under ARS § 28-5739.
7. Aviation fuel subject to the tax imposed under ARS § 28-8344.
8. Pipes or valves four inches in diameter or greater to be used for transportation of oil, natural gas, artifi cial gas, water or coal slurry.
9. Neat animals, horses, asses, sheep, ratites, swine or goats used as breeding or production stock (including ownership shares in such animals).
10. Aircraft, navigational and communication instruments and related accessories sold or leased to:
Airlines holding a federal certifi cate of public convenience and necessity; or Airlines holding a foreign air carrier permit for air transportation; or
Any foreign government or nonresidents of Arizona who will not use such property in Arizona other than in removing such property from this state.
11. Railroad rolling stock, rails, ties and signal control equipment used directly to transport persons or property for hire.
12. Buses or urban mass transit vehicles used directly to transport persons or property for hire or pursuant to a government mass transit program.
13. Central offi ce switching equipment, switchboards, private branch exchange equipment, microwave radio equipment and carrier.
Equipment including optical fi ber, coaxial cable and other transmission media which are components of carrier systems sold or leased to
persons engaged in the telecommunications business.
14. New machinery and equipment, used for commercial production of agricultural, horticultural, viticultural and fl oricultural crops and
products in this state, consisting of tractors, tractor-drawn implements, self-powered implements, drip irrigation lines, and machinery
and equipment necessary for extracting milk and for cooling milk and livestock.
15. Machinery, equipment or transmission lines used directly in producing or transmitting electrical power, but not including distribution.
(OVER)
This exemption Certifi cate is prescribed by the Department of Revenue pursuant to ARS § 42-5009. The purpose of the certifi cate is to document
tax-exempt transactions with qualifi ed purchasers. It is to be fi lled out completely by the purchaser and furnished to the vendor. The vendor shall
retain this Certifi cate for single transactions or for specifi ed periods as indicated below. Incomplete Certifi cates are not considered to be accepted
in good faith. Only one form of exemption can be claimed on a certifi cate.
This form replaces earlier
forms: 5000, 5001, 5002.
ARIZONA FORM
5000
Purchaser’s Name and Address Check Applicable Box:
Vendor’s Name
Single Transaction Certifi cate
Period From: Through:
Choose one transaction type per Certifi cate
Transactions with a Business Transactions with Native
Americans & Native American
Businesses
Transactions with
nonresidents
(Please check appropriate item from numbers 1 - 19)
(Please check item number 24 or 24a)
(Please check appropriate item
from numbers 25 - 26)
Arizona Transaction Privilege Tax License Number
Other Tax License Number
Tax number for another tax agency
If no license number, provide reason:
Precise Nature of Purchaser’s Business
SSN / EIN Tribal Business License #
Tribal ID#
Name of Tribe
Transactions with a
Government entity or certain
Health Care Institutions
(Please check appropriate item
from numbers 1 - 23)
State of residence
Driver’s License#
Driver’s License
State
SSN/ID
30 day Drive
out permit #
(You must choose specifi c dates for which certifi cate will be valid)
OR
16. Groundwater measuring devices required under ARS § 45-604.
17. Machinery or equipment used directly in the following processes:
Manufacturing, processing or fabricating. Job printing. Refi ning or metallurgical operations.
Extraction of ores or minerals from the earth for commercial purposes. Extraction of, or drilling for, oil or gas from the earth for commercial purposes.
18. Printed, photographic, electronic media or digital media materials purchased by or for publicly funded libraries including school district
libraries, charter school libraries, community college libraries, state university libraries or federal, state, county or municipal libraries for
use by the public.
19. Other: Cite specifi c statutory authority for the exemption of the tangible personal property.
Exemptions based on the purchaser being a government entity, public school, or a qualifying health care institution.
20. Food, drink or condiments for consumptions within the premises of any prison, jail or other institution under the jurisdiction of the state department of
corrections, the department of public safety, the department of juvenile corrections or a county sheriff. Food, drink, condiments or accessories purchased
by a school district for consumption at a public school within the district during school hours.
21. Tangible personal property sold or leased directly to the United States Government or its departments or agencies by a manufacturer, modifi er, assembler
or repairer.
22. Fifty percent of the gross proceeds or gross income from the sale of tangible personal property directly to the United States Government or its
departments or agencies, which is not deducted under number 21 above. This exemption does not apply to leases.
23. Tangible personal property sold or leased directly to a qualifying non profi t hospital, health care organization, community health center, or rehabilitation
program for mentally or physically handicapped persons (an exemption letter for these entities must accompany this form).
Transactions with Native Americans & Native American Businesses
24. Sale or lease of tangible personal property including Motor Vehicles to affi liated Native Americans if the solicitation for the sale, signing of the contract,
delivery of the goods and payment for the goods all occur on the reservation.
24a. Sale of a Motor Vehicle to an enrolled member of a tribe who resides on the reservation established for that tribe.
Transactions with nonresidents
25. Sales of tangible personal property to nonresidents of Arizona who are temporarily within Arizona, for their use outside of Arizona, when the vendor ships
the property out of Arizona by common carrier or United States mail or delivers such property out of Arizona via the vendor’s own conveyance.
NOTE: The vendor shall retain adequate documentation substantiating the shipment of the property out of Arizona.
26. Sale of a motor vehicle (vehicle must be self-propelled) to a nonresident of Arizona whose state of residence does not allow a use tax exemption for
transaction privilege taxes paid to Arizona and who has secured a special 30-day nonresident registration for the vehicle (please see Arizona Form 5010).
ADOR 60-2010 (12/04)
Describe the tangible personal property or service purchased or leased and its use below. (Use additional pages if needed)
Describe the tangible personal property or service purchased or leased and its use below. (Use additional pages if needed)
Certifi cation
Certifi cation
A vendor that has reason to believe that the certifi cate is not accurate or complete will not be relieved of the
A vendor that has reason to believe that the certifi cate is not accurate or complete will not be relieved of the
burden of proving entitlement to the exemption. A vendor that accepts a certifi cate in good faith will be relieved
burden of proving entitlement to the exemption. A vendor that accepts a certifi cate in good faith will be relieved
of the burden of proof and the purchaser may be required to establish the accuracy of the claimed exemption.
of the burden of proof and the purchaser may be required to establish the accuracy of the claimed exemption.
If the purchaser cannot establish the accuracy and completeness of the information provided in the certifi cate,
If the purchaser cannot establish the accuracy and completeness of the information provided in the certifi cate,
the purchaser is liable for an amount equal to the transaction privilege tax, penalty and interest which the vendor
the purchaser is liable for an amount equal to the transaction privilege tax, penalty and interest which the vendor
would have been required to pay if the vendor had not accepted the certifi cate. Misuse of this Certifi cate will
would have been required to pay if the vendor had not accepted the certifi cate. Misuse of this Certifi cate will
subject the purchaser to payment of the ARS § 42-5009 amount equal to any tax, penalty or interest. Willful misuse
subject the purchaser to payment of the ARS § 42-5009 amount equal to any tax, penalty or interest. Willful misuse
of this Certifi cate will subject the purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
of this Certifi cate will subject the purchaser to criminal penalties of a felony pursuant to ARS § 42-1127.B.2.
I, (print full name) _____________________________________________, hereby certify that these transactions are
I, (print full name) _____________________________________________, hereby certify that these transactions are
exempt from Arizona transaction privilege tax and that the information on this Certifi cate is true, accurate and complete.
exempt from Arizona transaction privilege tax and that the information on this Certifi cate is true, accurate and complete.
Further, if purchasing or leasing as an agent or offi cer, I certify that I am authorized to execute this Certifi cate on behalf of
Further, if purchasing or leasing as an agent or offi cer, I certify that I am authorized to execute this Certifi cate on behalf of
the purchaser named above.
the purchaser named above.
Signature of purchaser
Signature of purchaser
__________________________________________________________________
__________________________________________________________________
Date
Date
_________________________
_________________________
Title
Title
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
