Iowa Tax Exemption Form

Iowa Tax Exemption Form

This document is to be completed by a purchaser when claiming exemption from sales/use/excise tax. Certificates are valid for up to three years.
Purchaser legal name:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
General nature of business: *
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Purchaser is doing business as:*

RetailerRetailer car dealerGovernmental agencyWholesalerFarmerLessorManufacturerNonprofit hospitalPrivate nonprofit educational institutionQualifying residental care facilityNonprofit museumCommercial enterpriseNonprofit food bankOther
Permit Number (if retailer is selected above)
Purchaser is claiming exemption for the following reason:*
Description of purchase (include additional information if necessary)
I, the undersigned, declare under penalties of perjury or false certificate, that I have examined this certificate, and, to the best of my knowledge and belief, it is true, correct, and complete.
Signature of purchaser*

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