REV-1220 AS + (08-14)

PENNSYLVANIA EXEMPTION
CERTIFICATE This form cannot be used to
START obtain a Sales Tax Account
CHECK ONE:
➜ ID, PTA Account ID or Exempt
® STATE OR LOCAL SALES AND USE TAX Status.
BUREAU OF
® STATE OR LOCAL HOTEL OCCUPANCY TAX
BUSINESS TRUST FUND TAXES ® PUBLIC TRANSPORTATION ASSISTANCE TAXES AND FEES (PTA)
PO BOX 280901 Read Instructions
HARRISBURG, PA 17128-0901 ® VEHICLE RENTAL TAX (VRT)
(Please Print or Type)
On Reverse Carefully
THIS FORM MAY BE PHOTOCOPIED – VOID UNLESS COMPLETE INFORMATION IS SUPPLIED
CHECK ONE: ® PENNSYLVANIA TAX UNIT EXEMPTION CERTIFICATE (USE FOR ONE TRANSACTION)
® PENNSYLVANIA TAX BLANKET EXEMPTION CERTIFICATE (USE FOR MULTIPLE TRANSACTIONS)
Name of Seller, Vendor or Lessor

Street City State ZIP Code

NOTE: Do not use this form for claiming an exemption on the registration of a vehicle. To claim an exemption from tax for a motor vehicle, trailer, semi-trailer
or tractor with the PA Department of Transportation, Bureau of Motor Vehicles, use one of the following forms:
FORM MV-1, Application for Certificate of Title (first-time registrations)
FORM MV-4ST, Vehicle Sales and Use Tax Return/Application for Registration (other registrations)
Property and services purchased or leased using this certificate are exempt from tax because: (Select the appropriate paragraph from the back of this form,
check the corresponding block below and insert information requested.)
® 1. Property or services will be used directly and predominately by purchaser in performing purchaser's operation of:

® 2. Purchaser is a/an:

® 3. Property will be resold under Account ID ____________________________. (If purchaser does not have a PA Sales Tax Account ID, include
a statement under Number 7 explaining why a number is not required.)
® 4. Purchaser is a/an: ______________________________________________________ holding Exemption Account ID

® 5. Property or services will be used directly and predominately by purchaser performing a public utility service.
® PA Public Utility Commission PUC Number ______________ and/or ® U.S. Department of Transportation MC/MX
® 6. Exempt wrapping supplies, Account ID ____________________________. (If purchaser does not have a PA Sales Tax Account ID, include
a statement under Number 7 explaining why a number is not required.)
® 7. Other
(Explain in detail. Additional space on reverse side.)

I am authorized to execute this certificate and claim this exemption. Misuse of this certificate by seller, lessor, buyer, lessee or their representative is
punishable by fine and imprisonment.
Name of Purchaser or Lessee Signature EIN Date
Please sign after printing.
Street City State ZIP Code

1. ACCEPTANCE AND VALIDITY:

For this certificate to be valid, the seller/lessor shall exercise good faith in accepting this certificate, which includes: (1) the certificate shall be completed
properly; (2) the certificate shall be in the seller/lessor's possession within 60 days from the date of sale/lease; (3) the certificate does not contain informa-
tion which is knowingly false; and (4) the property or service is consistent with the exemption to which the customer is entitled. For more information, refer to
Exemption Certificates, Title 61 PA Code §32.2. An invalid certificate may subject the seller/lessor to the tax.

2. REPRODUCTION OF FORM:
This form may be reproduced but shall contain the same information as appears on this form.

3. RETENTION:
The seller or lessor must retain this certificate for at least four years from the date of the exempt sale to which the certificate applies.
DO NOT RETURN THIS FORM TO THE PA DEPARTMENT OF REVENUE.
4. EXEMPT ORGANIZATIONS:
This form may be used in conjunction with form REV-1715, Exempt Organization Declaration of Sales Tax Exemption, when a purchase of $200 or more is
made by an organization which is registered with the PA Department of Revenue as an exempt organization. These organizations are assigned an exemp-
tion number, beginning with the two digits 75 (example: 75-00000-0).
Reset Form NEXT PAGE PRINT
 GENERAL INSTRUCTIONS
Those purchasers set forth below may use this form in connection with the claim for exemption for the following taxes:
a. State and local sales and use tax;
b. PTA rental fee or tax on leases of motor vehicles;
c. Hotel occupancy tax if referenced with the symbol (l);
d. PTA fee on the purchase of tires if referenced with the symbol (+);
e. Vehicle rental tax (VRT)

EXEMPTION REASONS
1.) Property and/or services will be used directly and predominately by purchaser in performing purchaser's operation of:
A. Manufacturing B. Mining C. Dairying D. Processing E. Farming F. Shipbuilding

This exemption is not valid for property or services used in: (a) constructing, repairing or remodeling of real property, other than real property used directly in
exempt operations; or (b) maintenance, managerial, administrative, supervisory, sales, delivery, warehousing or other nonoperational activities. Effective
October 1, 1991, this exemption does not apply to certain services and PTA tire fee.

2.) Purchaser is a/an:

+ A. Instrumentality of the commonwealth.
+ B. Political subdivision of the commonwealth.
+ l C. Municipal authority created under the Municipality Authorities Acts.
+ l D. Electric cooperative corporations created under the Electric Cooperative Law of 1990.
l E. Cooperative agricultural associations required to pay corporate net income tax under the Cooperative Agricultural Association Corporate Net
Income Tax Act (exemption not valid for registered vehicles).
+ l F. Credit unions organized under Federal Credit Union Act or commonwealth Credit Union Act.
+ l G. U.S. government, its agencies and instrumentalities.
l H. Federal employee on official business (exemption limited to hotel occupancy tax only. A copy of orders or statement from supervisor must be
attached to this certificate.)
I. School bus operator (This exemption certificate is limited to the purchase of parts, repairs or maintenance services upon vehicles licensed as
school buses by the PA Department of Transportation.)

3.) Property and/or services will be resold or rented in the ordinary course of purchaser's business. If purchaser does not have a PA Sales Tax Account ID,
complete Number 7 explaining why such number is not required. This exemption is valid for property or services to be resold: (1) in original form; or (2) as an
ingredient or component of other property.
4.) Renewable Entities beginning Permanent Exemptions beginning with Special Exemptions:
with “75”: the two numbers “76”:
A. Religious Organization E. School District F. Direct Pay Permit Holder
B. Volunteer Firemen's Organization + l G. Individual Holding Diplomatic ID
C. Nonprofit Educational Institution H. Keystone Opportunity Zone
D. Charitable Organization I. Tourist Promotion Agency

Exemption limited to purchase of tangible personal property or services for use and not for sale. The exemption shall not be used by a contractor performing
services to real property. An exempt organization or institution shall have an Account ID assigned by the PA Department of Revenue and diplomats shall have an
identification card assigned by the federal government. The exemption for categories A, B, C and D are not valid for property used for the following:
(1) construction, improvement, repair or maintenance or any real property, except supplies and materials used for routine repair or maintenance of the real
property; (2) any unrelated activities or operation of a public trade or business; or (3) equipment used to maintain real property.

5.) Property or services will be used directly and predominately by purchaser in the production, delivery or rendition of public utility services as defined by the PA
Utility Code.
This exemption is not valid for property or services used for the following: (1) construction, improvement, repair or maintenance of real property, other than real
property used directly in rendering the public utility services; or (2) managerial, administrative, supervisor, sales or other nonoperational activities; or (3) tools
and equipment used but not installed in maintenance of facilities or direct use equipment. Tools and equipment used to repair "direct use" property are exempt
from tax.

6.) Vendor/seller purchasing wrapping supplies and nonreturnable containers used to wrap property which is sold to others.

7.) Other (Attach a separate sheet of paper if more space is required.)

Reset Form TO PAGE ONE PRINT