Tax Exempt 2025 Form.pdf

SECTION 1: TYPE OF PURCHASE check one of the followins

A- One-llme Purchase

Order or lnvoice Number:

C. Blanket Certific€le

Expiration Date (maximum of four years)

Sellefs Name and Address

SECTION 2: ITEMS COVERED BY THIS CERTIFICATE

Check one of the following:

1. I Alt items purcrrased.

2 Limiied to the following items

SECTION 3: BASIS FOR EXEMPTION CLAIM

Check one of the following:

7.

8.

s.

For Lease. Purchaserwill lease the property and elects to pay tax based on rental receipts. Enter sales tax license or use tax aegistralion number

For Resale at Retail. Enter Sales Tax License Numbec

! Oirect eay - Authorized to pay use lax on qualifed transaclions di.ectly to Michigan Treasury under account number:

The following eremptions DO NOT require the purchaser to provide a number

+. ! 4acururat eroouction. Enter percenta ge: Yo

5. I Govemment Entity (U.S. or its instrumentalities, State of Michigan or its political suMivisions), Nonprofit School, Nonprofit Hospital, Church or House of Religious Worship (circle Vpe of organization)

Contractor (provid€ Michiga n Sales and Use Tax Conhactor Eligibility Statemert (Form 3520))-

For Resale at Wholesale.

lndustrial Processing. Enter percentage: %

Nonprofit lntemal Revenue Code Section 50'l(cX3), 5o1(c)(4), or 50'l (cX19) Exempt Organization.

Nonprofit Organizaiion with an authorized letter issued by Michigan Oepartnent of Treasury pior to July '17, 1998 (sales tax) or June 13, '1994 (use tax).

Rolling Stock purchased by an lnterstate Moto. Canier.

Other (explain)

SECTION 4: CERTIFICATION

I declare, under penav of pedury that the infonnation on this certificate is true, that I have consuhed the slatutes, administrative rules and other sources ot law applicable to my exemption, and that I have exercised reasonable care in assuing that my claim of exemption is valid under Michigan law. ln the event this claim is disallowed, I accept fu rcsponsibility for the payment of tax, penav and any accrued inlercst, including, if necessary, rcimbu$ement to the vendor fot tax and accrued intetest.

Type of Business (see codes on pase 2)

05 Government Bus ness Name

City of Warren City, State, ZIP Code

Warren, Ml 48093One City Square, Suite 425 Business Address

Name (Pnnt or Type)

Craig J. Treppa Business Telephone Nlmber (include area cade)

(5B6) 574-4639--, Purchasing Agent

TltleSignature Date Signed

0110312025

Michigan Depadrnent ol Trersury 3372 (Rev 01-21)

Michigan Sales and Use Tax Certificate of Exemption This exemption claim should be completed by the purchaser, provided to the seller, and is not valid unless the information in all four sections is complete. Do not send a copy to Treasury unless one is requested.

X B. Blanket Certificate. Recuning Business Relationship

The purchaser completing this form hereby claims exemption from tax on the purchase of tangible personal property or services purchased from the seller named below. This claim is based upon: the purchaser's proposed use ofthe p.operty or services: OR the purchaser's exempt status.

3372, Page 2 lnstructions for completing Michigan Sa/es and Use Tax Certificate of Exemption (Form 3372)

Purchasers may use this form to claim exemption from Michigan sales and use tax on qualified transactions. All fields must be completedi however, if provided to the purchaser in electronic format, a signalure is not required. All claims are subject to audit. The purchaser must ensure eligibility of the exemption claimed; a purchaser who improperly claims an exemption is liable for tax, penalty, and interest, with limited exceptions.

Sellers: Michigan does not issue "tax exempt numbers" and a seller is not permitted to rely on a number in lieu of a valid exemption claim. Sellers are required to maintain proper records of exempt sales, including exemption forms or the same information in another format- Records may be kept electronically. lf the exemption certificate is received in electronic format, a signature is not required. A seller who does not comply with these requirements may be liable for tax, penalty, and interest. See Revenue Administrative Bulletin 2016-14 for more information. All claims are subject to audit.

SECTION 1:

A) Choose "One-Time Purchase" and include the invoice number this certifcate covers.

B) Choose "Blanket Certificate" if there is a "recurring business relationship." This exists when a period of not more than 12 months elapses between sales transactions between the seller and purchaser Parties do not need to renew this blanket exemption claim as long as the recuning business relationship exists.

C) Choose 'Blanket Certificate" and enter the expiration date (maximum four years) when there may be a period of more than 12 months between sales transactions. This option is best when purchaser and seller anticipate more than one exempt transaction before lhe expiration date but do not have or may nol maintain a recurring business relationship.

SECTION 3:

Check the box that applies and, if applicable, provide the required information. The exemptions listed are the most common. lf the exemption you are claiming is not listed, check "Othe/' and enler lhe qualifying exemption.

SECTION 4:

Purchaser must complete Section 4. A signature is only required if a paper form is used; in that case, the purchaser should sign and provide their title (for example, Purchasing Manager, President, Owner). For Type of Business, enter the number from the following list that best describes the purchaser's business.

o4

Ulilities Wholesale Advertising, newspaper Non-Proft Hospital Non-Profit Educational Non-Profitso'l (cX3), 501(cX4), or 501(cX19) Other (enter code and write in business type)

SECTION 2:

Place a check in the box for'All items purchased" or choose "Limited to" and list the items that are covered by the exemption claim.

Accommodations Agricultural Construction Manufacturing Govemment Rental or leasing Retail Church Transportation

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