TAXEXEMPTCHILDRESS.pdf

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

Form ST-5 Sales Tax Exempt

Purchaser Certificate

This form is approved by the Commissioner of Revenue and may be reproduced.

Rev. 6/09

Massachusetts

Department of

Revenue

UNITED STATES PROPERTY AND FISCAL OFFICE FOR MASSACHUSETTS

2 RANDOLPH ROAD

HANSCOM AFB MA 01731

E 046--006--130

01/20/2022 NOT APPLICABLE

20 JAN 2022USPFO-MA

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-emption (Form ST-2) from the Commissioner of Revenue certifying that it is entitled to exemption under G.L. c.64H, §6(e). The 501(c)(3) organization must submit to the vendor a properly completed Sales Tax Exempt Pur-chaser Certificate (Form ST-5) signed by the 501(c)(3) organization with a copy of its Form ST-2 attached.

Any person, group or organization purchasing as an agent on behalf of a 501(c)(3) organization must certify that it is doing so by presenting to the vendor a properly completed Form ST-5 signed by the 501(c)(3) organiza-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 Form ST-5.

Any government organization is encouraged to obtain a Certificate of Ex-emption (Form ST-2) from the Commissioner of Revenue, certifying that it is entitled to exemption under G.L. c.64, § 6(d). The exempt government organization is encouraged to submit to the vendor a properly completed 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 ST-5, the vendor must maintain adequate documentation (generally, a copy of the government check) verifying that the purchaser is an exempt gov-ernment agency.

Any person, group or organization purchasing on behalf of exempt govern-ment organizations must certify that they are doing so by presenting to the vendor a properly executed Form ST-5 when making such purchases. Part

1 of Form ST-5 should be filled out by the exempt government organiza-tion. If Part 1 is not completed by the exempt government organization, the agent must enter the name, address, and, if available, the exemption num-ber of the government organization on whose behalf the purchases are be-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-ernment organization. The purchaser must attach to the Form ST-5 a copy of the exempt government organization’s Form ST-2 if available. If it is not available, the purchaser must enter the exemption number of the exempt government organization.

Other information for vendors Vendors should verify the validity of the certificate presented to them by checking the expiration date on the certificate. Vendors must not honor a Certificate of Exemption that has expired.

Government organization maintain Form ST-2 Certificates of Exemption that have an expiration date of “None.”

Vendors should call the Customer Service Bureau at (617) 887-6367 if they have any questions regarding a Certificate of Exemption which is presented to them.

If you have any questions about completing this certificate, please contact:

Massachusetts Department of Revenue, Customer Service Bureau, 200 Arlington Street, Chelsea, MA 02150; (617) 887-6367.

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