Utah State Tax Commission
Sales Tax Exemption Certificate Rev. 4/95
For Non-Utah Retailers Accepting Delivery of Merchandise in Utah
To (Name of Vendor):
This is to certify that is a dealer in tangible personal
property or services and that the tangible personal property or services purchased from the above-named vendor and shown on
invoice number(s) are for resale as tangible personal property or
services. The property will NOT be used in real property contract work or for any other personal or business use. My retail sales
license number in the state of is .
This certificate shall be valid only for the specific purchases referenced by the invoice number(s) noted above. A new certificate must
be completed each time a non-Utah retailer accepts delivery of merchandise in Utah.
To be valid this certificate must be filled in completely including date, signature and license number.
Please sign this form by hand after it is printed.
Name of Business (print or type)
State Zip Code
IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form
DO NOT SEND THIS CERTIFICATE TO THE TAX COMMISSION
NOTE TO VENDOR:------- Keep this certificate on file since it must be available for audit review.
NOTE TO PURCHASER:------- Keep a copy of this certificate for your records. You are responsible to
notify the vendor of cancellation, modification, or limitation of the exemption you have claimed.
Questions about the propriety of accepting this certificate from an out-of-state customer should be directed to Taxpayer
Services Division, Utah State Tax Commission, 210 N 1950 W, Salt Lake City, Utah 84134, Telephone (801) 297-2200, or toll
If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 or
TDD (801) 297-3819. Please allow three working days for a response.
TC-721NR.CDR Rev. 4/95