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RESET FORM PRINT FORM Nebraska Resale or Exempt Sale Certificate Form for Sales Tax Exemption Name and Mailing Address of Purchaser Name and Mailing Address of Seller Name 13 Name Legal Name Street Address (Do not use PO Box) City Street or Other Mailing Address State Zip Code City State Zip Code Check Type of Certificate c Single Purchase If single purchase is checked, enter the related invoice or purchase order number ______________________________________. c Blanket If blanket is checked, this certificate is valid until revoked in writing by the purchaser. I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason: Check One c Purchase for Resale (Complete Section A.) c Exempt Purchase (Complete Section B.) c Contractor (Complete Section C.) Section A — Nebraska Resale Certificate Description of Property or Service Purchased I hereby certify that the purchase, lease, or rental of ________________________________________________________________from the seller listed above is exempt from the Nebraska sales tax as a purchase for resale, rental, or lease in the normal course of our business. The property or service will be resold either in the form or condition in which it was purchased, or as an ingredient or component part of other property or service to be resold. I further certify that we are engaged in business as a: c Wholesaler c Retailer c Manufacturer c Lessor of Description of Product or Service Sold, Leased, or Rented ___________________________________________________________________________________________________________________. My Nebraska Sales Tax Permit Number is 01-_________________________________. If none, state the reason _____________________________________________________________________________________________________, or Foreign State Sales Tax Number__________________________________________ State __________________________________________. Section B — Nebraska Exempt Sale Certificate The basis for this exemption is exemption category ______ (insert appropriate number for the category of exemption described on the reverse side). If exemption category 2 or 5 is claimed, enter the following information: Description of Items Purchased Intended Use of Items Purchased _________________________________________________________________________________________________________________________. If exemption category 3 or 4 is claimed, enter your Nebraska Exemption Certificate number. 05 -______________________________ Do not enter your Federal Employer ID Number. If exemption category 6 is claimed, the seller must enter the following information and sign this form below: Description of Items Sold Date of Seller’s Original Purchase Was tax paid when purchased by seller? c Yes c No Was item depreciable? c Yes c No Section C — For Contractors Only 1. Purchase of building materials or fixtures. c As an Option 1 or Option 3 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above are exempt from Nebraska sales tax. My Nebraska Sales or Use Tax Permit Number is: _____________________________________________________. 2. Purchases made by an Option 2 contractor under a Purchasing Agent Appointment on behalf of_________________________ (exempt entity) ________________________________________. As an Option 2 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above is exempt from Nebraska sales tax pursuant to the attached Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17. Any purchaser, agent, or other person who completes this certificate for any purchase which is not for resale, lease, or rental in the regular course of the purchaser’s business, or is not otherwise exempted from sales and use taxes is subject to a penalty of $100 or ten times the tax, whichever amount is larger, for each instance of presentation and misuse. With regard to a blanket certificate, this penalty applies to each purchase made during the period the blanket certificate is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct and complete. sign here Authorized Signature Title Date Authorized Signature Name (please print) Do not send this certificate to the Nebraska Department of Revenue. Keep it as part of your records. Sellers cannot accept incomplete certificates. 6-134-1970 Rev. 10-2014 revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729 Supersedes 6-134-1970 Rev. 3-2009 Instructions Who May Issue a Resale Certificate. Form 13, Section A, is issued by persons or organizations making purchases of property or taxable services that will subsequently be resold in the purchaser’s normal course of business. The property or services must be resold in the same form or condition as when purchased, or as an ingredient or component part of other property that will be resold. Who May Issue an Exempt Sale Certificate. Form 13, Section B, may only be issued by governmental units and persons or organizations that are exempt from paying Nebraska sales and use tax. Nonprofit organizations that are exempt from paying sales and use tax are listed in the Nebraska Sales Tax Exemption Chart. Enter the appropriate number from the “Categories of Exemption” in the space provided that properly reflects the basis for your exemption. If category 2 through 6 is the basis for exemption, you must complete the information requested in Section B. For additional information about proper issuance and use of this certificate, please review Reg-1-013, Sale for Resale – Resale Certificate, and Reg-1-014, Exempt Sale Certificate. Contractors. To make tax-exempt purchases of building materials and fixtures, Option 1 or Option 3 contractors must complete Form 13, Section C, Part 1. To make tax-exempt purchases of building materials and fixtures pursuant to a construction project for an exempt governmental unit or an exempt nonprofit organization, Option 2 contractors must complete Form 13, Section C, Part 2. The contractor must also attach a copy of a properly completed Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17, to the Form 13, and both documents must be given to the supplier when purchasing building materials. See the contractor information guides for additional information. When and Where to Issue. The Form 13 must be given to the seller at the time of the purchase to document why sales tax does not apply to the purchase. The Form 13 must be kept with the seller’s records for audit purposes (see Reg-1-012, Exemptions). Do not send Forms 13 to the Nebraska Department of Revenue. Sales Tax Number. A purchaser who is engaged in business as a wholesaler or manufacturer is not required to provide an ID number when completing Section A. Out-of-state purchasers may provide their home state sales tax number. Section B does not require a Nebraska ID number when exemption category 1, 2, or 5 is indicated. Fully Completed Resale or Exempt Sale Certificate. For a resale certificate to be fully completed, it must include: (1) identification of the purchaser and seller, type of business engaged in by the purchaser, and reason for the exemption; (2) sales tax permit number; (3) signature of an authorized person; and (4) the date of issuance. For an exempt sale certificate to be fully completed, it must include: (1) identification of purchaser and seller; (2) a statement that the certificate is for a single purchase or is a blanket certificate covering future sales; (3) a statement of the basis for exemption, including the type of activity engaged in by the purchaser; (4) signature of an authorized person; and (5) the date of issuance. Penalties. Any purchaser who gives a Form 13 to a seller for any purchase which is other than for resale, lease, or rental in the normal course of the purchaser’s business, or is not otherwise exempted from sales and use tax under the Nebraska Revenue Act, is subject to a penalty of $100 or ten times the tax, whichever is greater, for each instance of presentation and misuse. In addition, any purchaser, or their agent, who fraudulently signs a Form 13 may be found guilty of a Class IV misdemeanor. Categories of Exemption 1. Governmental agencies identified in Reg-1-012, Exemptions; Reg-1-072, United States Government and Federal Corporations; and Reg-1-093, Governmental Units. Governmental units are not assigned exemption numbers. Sales to the United States government, its agencies, instrumentalities, and corporations wholly owned by the U.S. government are exempt from sales tax. However, sales to institutions chartered or created under federal authority, but which are not directly operated and controlled by the United States government for the benefit of the public, generally are taxable. For construction projects for federal agencies, see Reg-1-017, Contractors. Purchases by governmental units that are not exempt from Nebraska sales and use taxes include, but are not limited to: governmental units of other states; sanitary and improvement districts; rural water districts; railroad transportation safety districts; and county historical societies. 2. Purchases when the intended use renders it exempt as stated in paragraph 012.02D of Reg-1-012, Exemptions. See Nebraska Sales Tax Exemption Chart. Complete the description of the item purchased and the intended use on the front of Form 13. Beginning October 1, 2014, sales of repair and replacement parts for agricultural machinery and equipment used in commercial agriculture are exempt from sales and use taxes. When claiming this exemption, please enter “commercial agriculture” on the Intended Use of Items Purchased line. 3. Purchases made by organizations that have been issued a Nebraska Exempt Organization Certificate of Exemption. Reg-1-090, Nonprofit Organizations; Reg-1-091, Religious Organizations; and Reg-1-092, Educational Institutions, identify these organizations. These organizations are issued a Nebraska state exemption ID number. This exemption number must be entered in Section B of Form 13. Nonprofit health care organizations that hold a certificate of exemption are exempt for purchases of items for use at their facility, or portion of the facility, covered by the license issued under the Health Care Facility Licensure Act. Only specific types of health care facilities and activities are exempt. Purchases of items for use at facilities that are not covered under the license, or for any other activities that are not specifically exempt, are taxable. 4. Purchases of common or contract carrier motor vehicles, trailers, and semitrailers; accessories that physically become part of a common or contract carrier vehicle; and repair and replacement parts for these vehicles. The exemption number must be entered in Section B of the Form 13. 5. Purchases of manufacturing machinery and equipment made by a person engaged in the business of manufacturing, including repair and replacement parts or accessories, for use in manufacturing. 6. Occasional sales of used business or farm machinery or equipment productively used by the seller as a depreciable capital asset for more than one year in his or her business. The seller must have previously paid tax on the item being sold. The seller must complete, sign, and give the exemption certificate to the purchaser.
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