NCDOR E-595E Streamlined Sales and Use Tax Certificate of Exemption

NCDOR E-595E Streamlined Sales and Use Tax Certificate of Exemption
Do not send this form to the Streamlined Sales Tax Governing Board or the NC Department of Revenue. Send the completed form to the seller and keep a copy for your records. This is a multi-state form for use in the states listed. Not all states allow all exemptions listed on this form. The purchaser is responsible for ensuring it is eligible for the exemption in the state it is claiming the tax exemption from. Check with the state for exemption information and requirements. The purchaser is liable for any tax and interest, and possible civil and criminal penalties imposed by the state, if the purchaser is not eligible to claim this exemption.
Check if this certificate is for a single purchase. Enter the related invoice/purchase order #
Enter the related invoice/purchase order #*
A. Purchaser's name*
B. Business address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
C. Name of seller from whom you are purchasing, leasing, or renting*
D. Seller's address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
01 Accommodation and food services02 Agricultural, forestry, fishing, and hunting03 Construction04 Finance and insurance05 Information, publishing, and communications06 Manufacturing07 Mining08 Real estate09 Rental and leasing10 Retail trade11 Transportation and warehousing12 Utilities13 Wholesale trade14 Business services15 Professional services16 Education and health-care services17 Nonprofit organization18 Government19 Not a businessOther
A Federal government (department)B State government (name)C Tribal government (name)D Foreign diplomat #G Resale #H Agricultural production #I Industrial production/manufacturing #J Direct pay permit #K Direct mail #Other
G Resale #*
A Federal government (department)*
B State*
B State government name*
C Tribal government (name)*
D Foreign diplomat #*
H Agricultural production #*
I Industrial production/manufacturing #*
J Direct pay permit #*
K Direct mail #*

Identification (ID) number. Enter the ID number as required in the instructions for each state in which you are claiming an exemption. If claiming multiple exemption reasons, enter the letters identifying each reason as listed in Section 4 for each state.

Rows	ID Number	State/Country	Reason
AR
GA
IA
IN
KS
KY
MI
MN
NC
ND
NE
NJ
NV
OH
OK
RI
SD
TN
UT
VT
WA
WI
WV
WY

6 Sign and Date. I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.*
Print name here*
Title*
Date

MonthDayYear
Date
Phone number*
Format: (000) 000-0000.
E-mail address*
example@example.com
Should be Empty: