Form CERT-121 Exemption for Landscaping and Horticulture Services, Window Cleaning Services, and Maintenance Services Provided to Recipients of Total Disability Benefits - Connecticut

Form CERT-121 or the "Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits" is a form issued by the Connecticut Department of Revenue Services.

The form was last revised in July 1, 2003 and is available for digital filing. Download an up-to-date Form CERT-121 in PDF-format down below or look it up on the Connecticut Department of Revenue Services Forms website.

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Department of Revenue Services
State of Connecticut
25 Sigourney Street
Hartford CT 06106-5032
CERT-121
(Revised 07/03)
Exemption for Landscaping and Horticulture Services,
Window Cleaning Services, and Maintenance Services
Provided to Recipients of Total Disability Benefits
General Purpose: A person eligible for and currently
Instructions for the Seller: Acceptance of this certificate,
receiving total disability benefits under Title II of the Social
when properly completed, relieves the seller from the burden
Security Act (42 USC §401 et seq.) uses this certificate to
of proving that the sale and the consumption of landscaping
purchase landscaping and horticulture services, window
and horticulture services, window cleaning services, or
cleaning services, or maintenance services when the services
maintenance services are not subject to sales and use taxes.
are provided at that person’s residence. If the services
This certificate is valid only if taken in good faith from a person
purchased exempt under this certificate are not provided at
eligible for and receiving total disability benefits under the Social
the person’s residence, the purchaser who claimed the
Security Act who is purchasing services to be provided at
exemption owes use tax on the total price of the services
that person’s residence. The good faith of the seller will be
purchased under the exemption.
questioned if the seller knows of facts that suggest that the
person furnishing this certificate is not receiving total disability
Statutory Authority: Conn. Gen. Stat. §12-412(85).
benefits under the Social Security Act or that the services are
to be provided at a location that is not the residence of that
Instructions for the Purchaser: A person eligible for and
person. Keep this certificate and bills or invoices to the
currently receiving total disability benefits under Title II of the
purchaser for at least six years from the date on which the
Social Security Act signs and issues this certificate to the
services were purchased. The bill, invoices, or records covering
provider of the services described above to purchase the
all purchases made under this certificate must be marked
services to be provided at that person’s home.
Exempt Under CERT-121 to indicate that the purchase was
For this exemption, a residence is a place of abode for which
not taxable.
the purchaser bears the primary financial responsibility of the
This certificate may be used for a single purchase, in which
upkeep. Therefore, a homeowner or condominium owner may
event the box marked Certificate for One Purchase Only
qualify for the exemption. However, the Department of
must be checked. This certificate may also be used for a
Revenue Services (DRS) will presume a renter or person
continuing line of purchases, in which event the box marked
living with a family member does not qualify unless there is a
Blanket Certificate must be checked. A blanket certificate
written agreement stating that the person receiving total
remains in effect for three years unless the purchaser revokes
disability benefits is responsible for the upkeep of the residence.
it in writing before the period expires.
In the event of an audit by DRS, the purchaser must be able
For More Information: Call Taxpayer Services at
to present a Third Party Query certificate from the Social
1-800-382-9463 (in-state) or 860-297-5962 (from
Security Administration proving the purchaser was eligible for
anywhere). TTY, TDD, and Text Telephone users only
and receiving total disability benefits at the time the services
may transmit inquiries anytime by calling 860-297-4911.
were purchased.
Preview and download forms and publications from the DRS
Keep a copy of this certificate for at least six years from the
Web site at www.ct.gov/DRS
date the services were purchased.
Department of Revenue Services
State of Connecticut
25 Sigourney Street
Hartford CT 06106-5032
CERT-121
(Revised 07/03)
Exemption for Landscaping and Horticulture Services,
Window Cleaning Services, and Maintenance Services
Provided to Recipients of Total Disability Benefits
General Purpose: A person eligible for and currently
Instructions for the Seller: Acceptance of this certificate,
receiving total disability benefits under Title II of the Social
when properly completed, relieves the seller from the burden
Security Act (42 USC §401 et seq.) uses this certificate to
of proving that the sale and the consumption of landscaping
purchase landscaping and horticulture services, window
and horticulture services, window cleaning services, or
cleaning services, or maintenance services when the services
maintenance services are not subject to sales and use taxes.
are provided at that person’s residence. If the services
This certificate is valid only if taken in good faith from a person
purchased exempt under this certificate are not provided at
eligible for and receiving total disability benefits under the Social
the person’s residence, the purchaser who claimed the
Security Act who is purchasing services to be provided at
exemption owes use tax on the total price of the services
that person’s residence. The good faith of the seller will be
purchased under the exemption.
questioned if the seller knows of facts that suggest that the
person furnishing this certificate is not receiving total disability
Statutory Authority: Conn. Gen. Stat. §12-412(85).
benefits under the Social Security Act or that the services are
to be provided at a location that is not the residence of that
Instructions for the Purchaser: A person eligible for and
person. Keep this certificate and bills or invoices to the
currently receiving total disability benefits under Title II of the
purchaser for at least six years from the date on which the
Social Security Act signs and issues this certificate to the
services were purchased. The bill, invoices, or records covering
provider of the services described above to purchase the
all purchases made under this certificate must be marked
services to be provided at that person’s home.
Exempt Under CERT-121 to indicate that the purchase was
For this exemption, a residence is a place of abode for which
not taxable.
the purchaser bears the primary financial responsibility of the
This certificate may be used for a single purchase, in which
upkeep. Therefore, a homeowner or condominium owner may
event the box marked Certificate for One Purchase Only
qualify for the exemption. However, the Department of
must be checked. This certificate may also be used for a
Revenue Services (DRS) will presume a renter or person
continuing line of purchases, in which event the box marked
living with a family member does not qualify unless there is a
Blanket Certificate must be checked. A blanket certificate
written agreement stating that the person receiving total
remains in effect for three years unless the purchaser revokes
disability benefits is responsible for the upkeep of the residence.
it in writing before the period expires.
In the event of an audit by DRS, the purchaser must be able
For More Information: Call Taxpayer Services at
to present a Third Party Query certificate from the Social
1-800-382-9463 (in-state) or 860-297-5962 (from
Security Administration proving the purchaser was eligible for
anywhere). TTY, TDD, and Text Telephone users only
and receiving total disability benefits at the time the services
may transmit inquiries anytime by calling 860-297-4911.
were purchased.
Preview and download forms and publications from the DRS
Keep a copy of this certificate for at least six years from the
Web site at www.ct.gov/DRS
date the services were purchased.
Name of Purchaser
Address
Social Security Number
Name of Seller
Address
CT Tax Registration Number
Federal Employer ID Number
(If None, explain)
Check One Box
Blanket Certificate
Certificate for One Purchase Only
Description of Services Purchased
Declaration by Purchaser
I am eligible for and am currently receiving total disability benefits under the Social Security Act. The services described on this certificate
are landscaping and horticulture services, window cleaning services, or maintenance services to be provided at my residence, as
described in Conn. Gen. Stat. §12-412(85).
In accordance with Conn. Gen. Stat. §12-412(85), the purchase of these services is not subject to sales and use taxes.
I declare under penalty of law that I have examined the information in this certificate and to the best of my knowledge and belief it is true,
complete, and correct. I understand the penalty for willfully delivering a false return to DRS is a fine of not more than $5,000, or
imprisonment for not more than five years, or both.
By:
Name of Purchaser
Signature
Date
CERT-121 (Back)
(Revised 07/03)

Download Form CERT-121 Exemption for Landscaping and Horticulture Services, Window Cleaning Services, and Maintenance Services Provided to Recipients of Total Disability Benefits - Connecticut

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