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01-929 *0192900W021703*PRINT FORM RESET FORM
(Rev.2-17/3)
*0192900W021703*
* 0 1 9 2 9 0 0 W 0 2 1 7 0 3 *
Exemption Certificate for Qualifying Data Centers or
Qualifying Large Data Center Projects
This form must be provided by a qualifying occupant, owner or operator to a seller for the purchase of items that qualify for exemption
from Texas state sales and use tax under Texas Tax Code Section 151.359 or Texas state and local sales and use tax under Tax Code
Section 151.3595. (See a list of qualifying and non-qualifying items on the back of this form.)
Check one: This exemption certificate is claimed for state sales and use tax only for qualifying data centers subject to Tax Code
Section 151.359.
This exemption is claimed for both state and local sales and use tax for qualifying large data center projects subject
to Tax Code Section 151.3595.
Seller Information
Name
Address (Street and number, P.O. Box or route number)
City, State, ZIP code Phone (Area code and number)
Purchaser Information
Qualifying Data Center name Qualifying Data Center registration number
Qualifying Occupant, Owner or Operator name Qualifying Occupant, Owner or Operator registration number
Qualifying Occupant, Owner or Operator address (Street and number, P.O. Box or route number) Check one
Occupant Owner Operator
City, State, ZIP code Phone (Area code and number)
I, the purchaser named above, claim an exemption from payment of sales and use taxes for the following items:
Description of items to be purchased or on the attached order or invoice
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 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.
Authorized Purchaser's signature Purchaser's name (Print or type) Date
This certificate should be furnished to the seller.
Do not send the completed certificate to the Comptroller of Public Accounts.
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