Texas Sales and Use Tax Exemption Certification

Texas Sales and Use Tax Exemption Certification
Name of purchaser, firm or agency
Address(Street & number, P.O. Box or Route number)
City, State, ZIP code
Phone Number
I, the purchaser named above, claim an exemption from payment of sales and use taxes (for the purchase of taxable items described below or on the attached order or invoice) from:
Seller
Address

Street address

Street Address Line 2

City, State, ZIP codeState / Province

Postal / Zip Code
Description of items to be purchased or on the attached order or invoice
Purchaser claims this exemption for the following reason
I understand that I will be liable for payment of all state and local sales or use taxes which may become due for failure to comply with the provisions of the Tax Code and/or all applicable law.

I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know, at the time of purchase, will be used in a manner other than that expressed in this certificate, and depending on the amount of tax evaded, the offense may range from a Class C misdemeanor to a felony of the second degree.
Signature

Clear
Title
Date

MonthDayYear
Date
NOTE: This certificate cannot be issued for the purchase, lease, or rental of a motor vehicle.

THIS CERTIFICATE DOES NOT REQUIRE A NUMBER TO BE VALID.

Sales and Use Tax "Exemption Numbers" or "Tax Exempt" Numbers do not exist.

This certificate should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public Accounts.
Should be Empty: