Arizona Form 5000, Arizona Department of Revenue Transaction Privilege Tax Exemption Certificate ADOR 60-2010 (12 and 04)

The following form has to be completed and submitted in order to acquire tax-exemptions on purchasers who are qualified in the State of Arizona. This form is also known as Form 5000.

Extracted Text for Proper Search

 



















 


	
Arizona Department of Revenue	
Transaction Privilege Tax Exemption Certifi cate	
ADOR 60-2010  (12/04)
Reason for Exemption - check as applicable
  1.  Tangible personal property to be resold in the ordinary course of business.
  2.  Tangible personal property to be leased or rented in the ordinary course of business.
  3.  Tangible personal property to be incorporated into a taxable contracting project.
  4.  Food, drink, or condiments purchased by a restaurant business.
  5.  Motor vehicle fuel and use fuel subject to tax under ARS § 28-5606 or 5708.
  6.  Use fuel to a holder of a valid single trip use fuel tax permit issued under ARS § 28-5739.
  7.  Aviation fuel subject to the tax imposed under ARS § 28-8344.
  8.  Pipes or valves four inches in diameter or greater to be used for transportation of oil, natural gas, arti cial gas, water or coal slurry.
  9.  Neat animals, horses, asses, sheep, ratites, swine or goats used as breeding or production stock (including ownership shares in such animals).
  10.  Aircraft, navigational and communication instruments and related accessories sold or leased to:
    Airlines holding a federal certi cate of public convenience and necessity; or    Airlines holding a foreign air carrier permit for air transportation; or
    Any foreign government or nonresidents of Arizona who will not use such property in Arizona other than in removing such property from this state.
  11.  Railroad rolling stock, rails, ties and signal control equipment used directly to transport persons or property for hire.
  12.  Buses or urban mass transit vehicles used directly to transport persons or property for hire or pursuant to a government mass transit program.
  13.  Central of ce switching equipment, switchboards, private branch exchange equipment, microwave radio equipment and carrier.
    Equipment including optical  ber, coaxial cable and other transmission media which are components of carrier systems sold or leased to
    persons engaged in the telecommunications business.
  14.  New machinery and equipment, used for commercial production of agricultural, horticultural, viticultural and  oricultural crops and
    products in this state, consisting of tractors, tractor-drawn implements, self-powered implements, drip irrigation lines, and machinery
    and equipment necessary for extracting milk and for cooling milk and livestock.
  15.  Machinery, equipment or transmission lines used directly in producing or transmitting electrical power, but not including distribution.
    
    	
(OVER) This exemption Certi cate is prescribed by the Department of Revenue pursuant to ARS § 42-5009.  The purpose of the certi cate is to document 
tax-exempt transactions with quali ed purchasers.  It is to be  lled out completely by the purchaser and furnished to the vendor.  The vendor shall 
retain this Certi cate for single transactions or for speci ed periods as indicated below.  Incomplete Certi cates are not considered to be accepted 
in good faith.  Only one form of exemption can be claimed on a certi cate.	
This form replaces earlier
forms: 5000, 5001, 5002.	
ARIZONA FORM	
5000	
Purchaser’s Name and Address Check Applicable Box:
Vendor’s NameSingle Transaction Certi cate
Period From: Through:
Choose one transaction type per Certi cate
Transactions with a Business Transactions with Native
Americans & Native American
BusinessesTransactions with 
nonresidents	
(Please check appropriate item from numbers 1 - 19)
(Please check item number 24 or 24a)(Please check appropriate item
from numbers 25 - 26) Arizona Transaction Privilege Tax License Number
Other Tax License Number
Tax number for another tax agency
If no license number, provide reason:
Precise Nature of Purchaser’s Business SSN / EIN
Tribal Business License # 
Tribal ID#
Name of Tribe	
Transactions with a 
Government entity or certain 
Health Care Institutions
(Please check appropriate item
from numbers 1 - 23)State of residence
Driver’s License#
Driver’s License
State
SSN/ID
30 day Drive
out permit # (You must choose specifi c dates for which certifi cate will be valid)
OR











 
 






 










  16.  Groundwater measuring devices required under ARS § 45-604.
  17.  Machinery or equipment used directly in the following processes:
      Manufacturing, processing or fabricating.  Job printing.  Re ning or metallurgical operations.
      Extraction of ores or minerals from the earth for commercial purposes.  Extraction of, or drilling for, oil or gas from the e
arth for commercial purposes.
  18.  Printed, photographic, electronic media or digital media materials purch\
ased by or for publicly funded libraries including  school district
    libraries, charter school libraries, community college libraries, state \
university libraries or federal, state, county or mun icipal libraries for
    use by the public.
  19.  Other: Cite speci c statutory authority for the exemption of the tangible personal propert\
y.
Exemptions based on the purchaser being a government entity, public school, or a qualifying health care institution.
  20.  Food, drink or condiments for consumptions within the premises of any pr\
ison, jail or other institution under the jurisdic tion of the state department of
    corrections, the department of public safety, the department of juvenile corrections or a county sheriff.  Food, drink, condi ments or accessories purchased
    by a school district for consumption at a public school within the distr\
ict during school hours.
  21.  Tangible personal property sold or leased directly to the United States G\
overnment or its departments or agencies by a man ufacturer, modi er, assembler
  or repairer.
  22.  Fifty percent of the gross proceeds or gross income from the sale of tan\
gible personal property directly to the United Sta tes Government or its    
    departments or agencies, which is not deducted under number 21 above.  This exemption does not apply to leases.
  23.  Tangible personal property sold or leased directly to a qualifying non pr\
o t hospital, health care organization, communit y health center, or rehabilitation  
    program for mentally or physically handicapped persons (an exemption le\
tter for these entities must accompany this form).
Transactions with Native Americans & Native American Businesses
 	
24.  Sale or lease of tangible personal property including Motor Vehicles to af liated Native Americans if the solicitation for  the sale, signing of the contract,  
    delivery of the goods and payment for the goods all occur on the reserva\
tion.
  24a. Sale of a Motor Vehicle to an enrolled member of a tribe who resides on the reservation e\
stablished for that tribe.	
Transactions with nonresidents
  25.  Sales of tangible personal property to nonresidents of Arizona who are temporarily within Arizona, for their use outside o f Arizona, when the  vendor ships
    the property out of Arizona by common carrier or United States mail or delivers such propert\
y out of Arizona via the vendor’s  own conveyance.
   NOTE:  The vendor shall retain adequate documentation substantiating the shipme\
nt of the property out of Arizona.
  26.  Sale of a motor vehicle (vehicle must be self-propelled) to a nonresid\
ent of Arizona whose state of residence does not all ow a use tax exemption for
    transaction privilege taxes paid to Arizona and who has secured a special 30-day nonresident registration fo\
r the vehicle (pl ease see Arizona Form 5010).
ADOR 60-2010  (12/04)
Describ e t h e t a n gib le  p ers o nal p ro perty  o r s erv ic e p urc h ased  o r le ased  a n d it s  u se b elo w .  ( U se a d dit io nal p ag es if  n eed ed )Describe the tangible personal property or service purchased or leased a\
nd its use below.  (Use additional pages if needed)	
C erti   c atio nCerti  cation	
A v en dor  th at  h as re aso n to  b elie ve th at  th e c ertifi  c ate  is  n ot  a ccu ra te  o r  c o m ple te  w ill  n ot  b e re lie ved  o f  th e A vendor that has reason to believe that the certifi  cate is not accurate or complete will not be relieved of the 
burd en  o f p ro vin g e n tit le m en t t o  t h e e xem ptio n.   A  v en dor t h at a ccep ts  a  c ertifi  c ate  in  g ood f a it h  w ill  b e r e lie ved  burden of proving entitlement to the exemption.  A vendor that accepts a certifi  cate in good faith will be relieved 
of  th e b urd en  o f  p ro of  a n d th e p urc h aser m ay b e r e q uir e d  to  e sta b lis h  th e a ccu ra cy o f  th e c la im ed  e xem ptio n. 
 of the burden of proof and the purchaser may be required to establish th\
e accuracy of the claimed exemption.   
If   th e p urc h aser c an not  e sta b lis h  th e a ccu ra cy a n d c o m ple te n ess o f  th e in fo rm atio n p ro vid ed  in  th e c ertifi  c ate , If the purchaser cannot establish the accuracy and completeness of the i\
nformation provided in the certifi  cate, 
th e p urc h aser i s  l ia b le  f o r a n  a m ount e q ual t o  t h e t r a n sactio n p riv ile g e t a x, p en alt y  a n d i n te re st w hic h  t h e v en dor the purchaser is liable for an amount equal to the transaction privilege\
 tax, penalty and interest which the vendor 
w ould  h ave b een  r e q uir e d  to  p ay if   th e v en dor h ad  n ot  a ccep te d  th e c ertifi  c ate .   M is u se o f  th is  C ertifi  c ate  w ill would have been required to pay if the vendor had not accepted the certi\
fi  cate.  Misuse of this Certifi cate  will 
su bje ct t h e p urc h aser t o  p aym en t o f t h e A RS §  4 2-5 009 a m ount e q ual t o  a n y t a x, p en alt y  o r i n te re st.  W illf u l m is u se subject the purchaser to payment of the ARS § 42-5009 amount equal to any tax, penalty or interest.  Willful misuse 
o f t h is  C ertifi   c ate  w ill s u bje ct t h e p urc h aser t o  c rim in al p en alt ie s o f a  f e lo ny p urs u an t t o  A RS §  4 2-1 1 27.B .2 .of this Certifi  cate will subject the purchaser to criminal penalties of a felony pursua\
nt to ARS § 42-1127.B.2.
I,  (p rin t  fu ll  n am e)  _ ____________________________________________,  h ere by c e rtif y  th at  th ese  tr a nsa ctio ns a re  I, (print full name) _____________________________________________, he\
reby certify that these transactions are 
exe m pt  fr o m  A riz o na tr a nsa ctio n p riv ile ge ta x a nd th at  th e in fo rm atio n o n th is  C ertifi  c a te  is  tr u e,  a ccu ra te  a nd c o m ple te .  exempt from Arizona transaction privilege tax and that the information on this Certi\
fi cate is true, accurate and complete.   
Furth er,  if   p urc h asin g o r le asin g a s a n a gent  o r o ffi c e r,   I  c e rtif y  th at  I  a m  a uth oriz e d to  e xe cu te  th is  C ertifi  c a te  o n b ehalf   o f Further, if purchasing or leasing as an agent or offi cer, I certify that I am authorized to execute this Certifi  cate on behalf of 
th e p urc h ase r n am ed a bove .the purchaser named above.
Sig natu re  o f p urc h aser Signature of purchaser 	_ _________________________________________________________________  __________________________________________________________________  	D ateDate	 _ ________________________ _________________________	
T it leTitle	 _ ________________________________________________________________________________________________________________ _______________________________________________________________________\
__________________________________________