EMPLOYER'S AUTHORIZATION TO MAKE PURCHASES ON BEHALF OF AN EXEMPT GOVERNMENTAL UNIT
_____________________________
DATE
TO: ________________________
SELLING DEALER'S NAME
___________________________
SELLING DEALER'S ADDRESS
I, the undersigned, am a representative of the exempt governmental unit identified below. The purchase or lease of tangible personal property or services or the rental of living quarters or sleeping accommodations made on or after _________ (DATE[S]) from the business identified above is for use by the exempt governmental unit identified below.
The charges for the purchase or lease of tangible personal property or services or the rental of living quarters or sleeping accommodations from the dealer identified above will be billed to and paid directly by the exempt governmental unit.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true.
__________________________________________________________________________________________________________
AUTHORIZED SIGNATURE ON BEHALF OF EXEMPT GOVERNMENTAL UNIT
__________________________________________________________________________________________________________
NAME OF EXEMPT GOVERNMENTAL UNIT
__________________________________________________________________________________________________________
ADDRESS OF EXEMPT GOVERNMENTAL UNIT
__________________________________________________________________________________________________________
CONSUMER'S CERTIFICATE OF EXEMPTION NUMBER
THIS CERTIFICATE MAY NOT BE USED TO MAKE PURCHASES OR LEASES OF TANGIBLE PERSONAL PROPERTY OR SERVICES OR RENTAL OF LIVING ACCOMMODATIONS FOR THE PERSONAL USE OF ANY INDIVIDUAL REPRESENTING THE EXEMPT ENTITY IDENTIFIED ABOVE.
EXEMPTION CERTIFICATE
TO BE USED BY FEDERAL EMPLOYEES
_____________________________
DATE
_________________________________
SELLING DEALER'S NAME
_________________________________
SELLING DEALER'S ADDRESS
I, the undersigned am an employee of the federal agency identified below. The purchase or lease of tangible personal property or services or the rental of living quarters or sleeping accommodations on or after __________ (DATE[S]) from the business identified above is in pursuit of my employer's affairs. The Government of the United States either will pay the seller directly or will provide reimbursement to the employee for the actual cost of the purchase or lease of tangible personal property, services, or living quarters or sleeping accommodations made on this date(s).
Under penalties of perjury, I declare that I have read the foregoing and the facts stated in it are true.
___________________________________
SIGNATURE OF EMPLOYEE
___________________________________
NAME OF FEDERAL AGENCY
___________________________________
ADDRESS OF FEDERAL AGENCY
THIS CERTIFICATE MAY NOT BE USED TO MAKE EXEMPT PURCHASES OR LEASES OF TANGIBLE PERSONAL PROPERTY OR SERVICES OR RENTAL OF LIVING ACCOMMODATIONS FOR THE PERSONAL USE OF ANY INDIVIDUAL EMPLOYED BY A UNITED STATES GOVERNMENTAL AGENCY. PROPER IDENTIFICATION IS REQUIRED BEFORE THIS CERTIFICATE MAY BE ACCEPTED BY THE SELLER.
EXEMPTION CERTIFICATE TO BE USED BY QUALIFYING
MUNICIPALLY-OWNED GOLF COURSE OPERATOR TO MAKE TAX EXEMPT PURCHASES
_______________________________ (Purchaser's Name) certifies that the tangible personal property purchased or leased on or after _______________ is exempt from sales tax, because the property will be used for the operation or maintenance of __________________________
(a municipally owned golf course), and that the following requirements have been met:
* Payment is made from golf course revenues or other funds provided by __________ (the municipality) for use by the purchaser;
* The municipally-owned golf course is located in a county with a minimum population of 2 million residents; and,
* Youth education programs are conducted on an ongoing basis at the municipally-owned golf course by a nonprofit organization exempt from federal income tax under s. 501(c)(3) of the Internal Revenue Code.
The undersigned understands that if the items purchased or leased do not qualify for exemption, or if the payment requirements listed above are not met, the undersigned will be subject to sales and use tax, interest, and penalties. Purchaser further understands that when any person shall fraudulently, for the purpose of evading tax, issue to a vendor or to any agent of the state a certificate or statement in writing in which he or she claims exemption from the sales tax, such person, in addition to being liable for payment of the tax plus a mandatory penalty of 200% of the tax, shall be liable for fine and punishment provided by law for conviction of a felony of the third degree, as provided in Section 775.082, 775.083, or 775.084, F.S.
___________________________ __________________
Purchaser's Name (Print or Type) Date
___________________________ __________________
Signature Title
_______________________________________________________________
Name and address of Municipally-Owned Golf Course
________________________________
Municipality's Consumer's Certificate of Exemption Number
____________________________
Transaction Authorization Number (Not necessary when selling dealer retains a copy of the municipality's consumer's certificate of exemption)
EXEMPTION CERTIFICATE FOR EXEMPTIONS BASED ON THE PROPERTY'S USE
This is to certify that the tangible personal property purchased, leased, licensed, or rented, or services purchased, on or after ________ (date) from _____________________ (Selling Dealer's Business Name) is purchased, leased, licensed, or rented for the following purpose as checked in the space provided. This is not intended to be an exhaustive list:
() Materials, containers, labels, sacks, bags, or similar items intended to accompany a product for sale at other than retail, as provided in Section 212.02(14)(c), F.S., by persons who are not required to be registered under Section 212.18(3), F.S.
() Incorporation into items of tangible personal property manufactured, produced, compounded, processed, or fabricated for one's own use, as provided in Rule 12A-1.043, F.A.C.
() Printing of a publication exempt under the provisions of Section 212.08(7)(w), F.S.
() Items, such as paper and ink, that will be incorporated into and become a component part of a publication exempt under the provisions of Section 212.08(7)(w), F.S.
() Educational materials, such as glue, paper, paints, crayons, unique craft items, scissors, books, and educational toys, purchased by child care facilities outlined in Section 402.305, F.S., that hold a current license under Section 402.308, F.S., hold a current Gold Seal Quality Care designation as provided in Section 1002.945, F.S., and provide all employees with basic health insurance as defined in Section 627.6699(12), F.S., as provided in Section 212.08(5)(m), F.S.
() Motor vehicle rented or leased by a dealer who will provide the motor vehicle at no charge to a person whose motor vehicle is being repaired, adjusted, or serviced by the dealer, as provided in Section 212.0601(4), F.S.
() Other (include description and statutory citation): ___________________________________________________________
I understand that if I use the property or service for any nonexempt purpose, I must pay tax on the purchase or lease price of the taxable property or service directly to the Department of Revenue.
I understand that if I fraudulently issue this certificate to evade the payment of sales tax I will be liable for payment of the sales tax plus a penalty of 200% of the tax and may be subject to conviction of a third degree felony.
The exemption specified by the purchaser may be verified by calling (850)488-6800.
Purchaser's Name___________________________________________________________________________________________
Purchaser's Address_________________________________________________________________________________________
Name and Title of Purchaser's Authorized Representative ___________________________________________________________
Sales and Use Tax Certificate of Registration No. (if applicable) ______________________________________________________
By_________________________________________
(Signature of Purchaser or Authorized Representative)
Title _____________________________________________________________
(Title - only if purchased by an authorized representative of a business entity)
Date ________
Fla. Admin. Code Ann. R. 12A-1.038
Rulemaking Authority 212.08(7), 212.18(2), 213.06(1) FS. Law Implemented 95.091(3), 212.07(1), 212.08(6), (7), 212.085, 213.012(2) FS.
New 10-7-68, Amended 6-16-72, 9-28-78, 7-20-82, 4-29-85, Formerly 12A-1.38, Amended 8-10-92, 3-17-93, 9-14-93, 12-13-94, 10-2-01, 6-12-03, 7-31-03, 6-28-04, 11-6-07, 9-1-09, 5-9-13, 2-17-15, 1-11-16, 1-17-18.