Form ST-5 "Sales Tax Exempt Purchaser Certificate" - Massachusetts

What Is Form ST-5?

This is a legal form that was released by the Massachusetts Department of Revenue - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2009;
  • The latest edition provided by the Massachusetts Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ST-5 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Revenue.

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Download Form ST-5 "Sales Tax Exempt Purchaser Certificate" - Massachusetts

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Rev. 6/09
Form ST-5
Massachusetts
Sales Tax Exempt
Department of
Purchaser Certificate
Revenue
Part 1. Exempt taxpayer information.
To be completed by exempt government or 501(c)(3) organization.
Name
Address
City
State
Zip
Exemption number
Issue date
Date of expiration of certificate
Certification is hereby made that the organization named above is an exempt purchaser under Massachusetts General Laws, Chapter 64H, sections 6(d)
or 6(e). All purchases of tangible personal property or services by this organization are exempt from taxation under said chapter to the extent that such
property or services are used in the conduct of the business of the purchaser. Any abuse or misuse of this certificate by any tax-exempt organization or
any unauthorized use of this certificate by any individual constitutes a serious violation and will lead to revocation.
Signature
Title
Date
Warning: Willful misuse of this certificate may result in criminal tax evasion sanctions of up to one year in prison and $10,000 ($50,000 for
corporations) in fines.
Part 2. Agent information.
To be completed by agent of exempt government or 501(c)(3) organization.
Name of agent’s organization
Address
City
State
Zip
Agent’s name
Address
City
State
Zip
I certify that in making this purchase, I am acting as an agent for the exempt organization named above (select one):
Government organization (local public school, city/town government, state agency, etc.).
Attach Form ST-2, if available. If Form ST-2 is not available, enter exemption number, if known:
501(c)(3) organization (parochial school, Scout troop, etc.). Form ST-2 must be attached.
Signature
Title
Date
Part 3. Vendor information
Vendor’s name
Check applicable box:
Single purchase certificate (attach detailed receipts or complete Part 4, on reverse)
Blanket certificate
This form is approved by the Commissioner of Revenue and may be reproduced.
Rev. 6/09
Form ST-5
Massachusetts
Sales Tax Exempt
Department of
Purchaser Certificate
Revenue
Part 1. Exempt taxpayer information.
To be completed by exempt government or 501(c)(3) organization.
Name
Address
City
State
Zip
Exemption number
Issue date
Date of expiration of certificate
Certification is hereby made that the organization named above is an exempt purchaser under Massachusetts General Laws, Chapter 64H, sections 6(d)
or 6(e). All purchases of tangible personal property or services by this organization are exempt from taxation under said chapter to the extent that such
property or services are used in the conduct of the business of the purchaser. Any abuse or misuse of this certificate by any tax-exempt organization or
any unauthorized use of this certificate by any individual constitutes a serious violation and will lead to revocation.
Signature
Title
Date
Warning: Willful misuse of this certificate may result in criminal tax evasion sanctions of up to one year in prison and $10,000 ($50,000 for
corporations) in fines.
Part 2. Agent information.
To be completed by agent of exempt government or 501(c)(3) organization.
Name of agent’s organization
Address
City
State
Zip
Agent’s name
Address
City
State
Zip
I certify that in making this purchase, I am acting as an agent for the exempt organization named above (select one):
Government organization (local public school, city/town government, state agency, etc.).
Attach Form ST-2, if available. If Form ST-2 is not available, enter exemption number, if known:
501(c)(3) organization (parochial school, Scout troop, etc.). Form ST-2 must be attached.
Signature
Title
Date
Part 3. Vendor information
Vendor’s name
Check applicable box:
Single purchase certificate (attach detailed receipts or complete Part 4, on reverse)
Blanket certificate
This form is approved by the Commissioner of Revenue and may be reproduced.
Part 4. Description of property purchased
Date
Description
Quantity
Cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Total cost
$
General information
An exempt 501(c)(3) organization must have obtained a Certificate of Ex-
1 of Form ST-5 should be filled out by the exempt government organiza-
emption (Form ST-2) from the Commissioner of Revenue certifying that it is
tion. If Part 1 is not completed by the exempt government organization, the
entitled to exemption under G.L. c.64H, §6(e). The 501(c)(3) organization
agent must enter the name, address, and, if available, the exemption num-
must submit to the vendor a properly completed Sales Tax Exempt Pur-
ber of the government organization on whose behalf the purchases are be-
chaser Certificate (Form ST-5) signed by the 501(c)(3) organization with a
ing made. Also enter a description of the property purchased into Part 4.
The agent must complete Part 2 when acting on behalf of the exempt gov-
copy of its Form ST-2 attached.
ernment organization. The purchaser must attach to the Form ST-5 a copy
Any person, group or organization purchasing as an agent on behalf of a
of the exempt government organization’s Form ST-2 if available. If it is not
501(c)(3) organization must certify that it is doing so by presenting to the
available, the purchaser must enter the exemption number of the exempt
vendor a properly completed Form ST-5 signed by the 501(c)(3) organiza-
government organization.
tion. It must also present a copy of the 501(c)(3) organization’s Form ST-2.
The agent of the exempt 501(c)(3) organization must complete Part 2 of
Other information for vendors
Form ST-5.
Vendors should verify the validity of the certificate presented to them by
Any government organization is encouraged to obtain a Certificate of Ex-
checking the expiration date on the certificate. Vendors must not honor a
emption (Form ST-2) from the Commissioner of Revenue, certifying that it
Certificate of Exemption that has expired.
is entitled to exemption under G.L. c.64, § 6(d). The exempt government
Government organization maintain Form ST-2 Certificates of Exemption that
organization is encouraged to submit to the vendor a properly completed
have an expiration date of “None.”
Sales Tax Exempt Purchaser Certificate (Form ST-5) with a copy of its
Form ST-2 attached. If the government organization does not present Form
Vendors should call the Customer Service Bureau at (617) 887-6367 if they
ST-5, the vendor must maintain adequate documentation (generally, a copy
have any questions regarding a Certificate of Exemption which is presented
of the government check) verifying that the purchaser is an exempt gov-
to them.
ernment agency.
If you have any questions about completing this certificate, please contact:
Any person, group or organization purchasing on behalf of exempt govern-
Massachusetts Department of Revenue, Customer Service Bureau,
ment organizations must certify that they are doing so by presenting to the
200 Arlington Street, Chelsea, MA 02150; (617) 887-6367.
vendor a properly executed Form ST-5 when making such purchases. Part
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