Streamlined Sales and Use Tax Agreement – New Jersey                                                                       Certificate of Exemption
This is a multistate form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they qualify
to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide this ex-
emption certificate (or the data elements required on the form) to a state that would otherwise be due tax on this sale.

The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state, if
the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-based exemption
on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based ex-
emption.
1.          Check if you are attaching the Multistate Supplemental form.
            If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.

2.          Check if this certificate is for a single purchase and enter the related invoice/purchase order #_______________________.

3.   Please print___________________________________________________________________________________________
      Name of purchaser
        __________________________________________________________________________________________________________________
      Business Address                                                                                  City                              State Zip Code
        __________________________________________________________________________________________________________________
        Purchaser’s Tax ID Number                                                                       State of Issuance                       Country of Issuance

        __________________________________________________________________________________________________________________
        If not Tax ID enter  FEIN                                                          Driver’s License Number/State Issued ID Number       Foreign diplomat number
        one of the following:
                                                                                             __________________________________________________________________________________________________________________State of Issuance: Number:
        Name of seller from whom you are purchasing, leasing or renting

      __________________________________________________________________________________________________________________
        Seller’s address                                                                                City                              State Zip Code

                __________________________________________________________________________________________________________________
4.    Type of business.      Circle the number that describes your business.
       01   Accommodation and food services                                              11     Transportation and warehousing
       02   Agricultural, forestry, fishing, hunting                                           12     Utilities
       03   Construction                                                                                 13     Wholesale trade
       04   Finance and insurance                                                                14     Business services
       05   Information, publishing, and communications                              15     Professional services
       06   Manufacturing                                                                              16     Education and health-care services
       07   Mining                                                                                          17     Nonprofit organization
       08   Real estate                                                                                   18     Government
       09   Rental and leasing                                                                       19     Not a business
       10   Retail trade                                                                                  20     Other (explain)________________________

5.    Reason for exemption.        Circle the letter that identifies the reason for exemption.
       A    Federal government (department) _______________                H      Agriculture production #________________________
       B    State or local government (name) _______________                I        Industrial production/manufacturing #_____________
            C    Tribal government (name) _____________________                J       Direct pay permit # ___________________________
       D    Foreign diplomat # ___________________________                K       Direct mail # ________________________________
       E    Charitable organization # ______________________                L       Other (explain) ______________________________
            F     Religious organization ________________________                M      Educational organization # _____________________
       G Resale # __________________________________

6. Sign here.

I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.

Signed authorized purchaser                                       Print name here                                         Title                 Date

_________________________________________________________________________________________________________

Streamlined Sales and Use Tax Agreement                        Certificate of Exemption – Multistate Supplemental
Name of Purchaser

STATE                      Reason for Exemption                Identification Number (if required)
   AR             __________________________________________________               _______________________________________
   GA             __________________________________________________               _______________________________________
   IA               __________________________________________________               _______________________________________
   IN              __________________________________________________               _______________________________________
   KS             __________________________________________________               _______________________________________
   KY             __________________________________________________               _______________________________________
   MI              __________________________________________________               _______________________________________
   MN            __________________________________________________               _______________________________________
   NC             __________________________________________________               _______________________________________
   ND             __________________________________________________               _______________________________________
   NE             __________________________________________________               _______________________________________
   NJ              __________________________________________________               _______________________________________
   NV             __________________________________________________               _______________________________________
   OH             __________________________________________________               _______________________________________
   OK             __________________________________________________               _______________________________________
   RI              __________________________________________________               _______________________________________
   SD             __________________________________________________               _______________________________________
   TN*            __________________________________________________               _______________________________________
   UT             __________________________________________________               _______________________________________
   VT             __________________________________________________               _______________________________________
   WA            __________________________________________________               _______________________________________
   WI              __________________________________________________               _______________________________________
   WV            __________________________________________________               _______________________________________
   WY            __________________________________________________               _______________________________________
*SSUTA Direct Mail provisions are not in effect for Tennessee. 
The following nonmember states will accept this certificate for exemption claims that are valid in their respective state.  SSUTA Direct Mail provisions do
not apply in these states. 

   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   XX             __________________________________________________               _______________________________________
   

                   Streamlined Sales and Use Tax Agreement – New Jersey
                      Certificate of Exemption Instructions

Use this form to claim exemption from sales tax on purchases of otherwise taxable items. The purchaser must
complete all fields on the exemption certificate and provide the fully completed certificate to the seller in order
to claim exemption.

Warning to purchaser: You are responsible for ensuring that you are eligible for the exemption you are claim-
ing. You will be held liable for any tax and interest, and possibly penalties imposed by the member state due
the tax on your purchase, if the purchase is not legally exempt.

Purchaser instructions for completing the exemption certificate

1.     Some purchasers may wish to complete a single certificate for multiple states where they 
       conduct business and, regularly, make exempt purchases from the same seller. If you do, 
       check the box on the front of the SSUTA Certificate of Exemption to indicate that you are 
       attaching the Multi-state Supplemental form.

       CAUTION: Certificates completed with a multistate supplement may include non- member 
       states of the SST Governing Board, provided those states have agreed to accept the SSUTA 
       Certificate of Exemption. Both sellers and purchasers MUST BE AWARE that these additional 
       non-member states may not have adopted the SSUTA provisions for Multiple Points of Use 
       and Direct Mail. Additionally, completion of this certificate in its entirety may not fully relieve the
       seller from liability unless non-member states’ requirements have been met.

       If you are not attaching the Multistate Supplemental form, enter the two-letter postal 
       abbreviation for the state under whose laws you are claiming exemption. For example, if you 
       are claiming an exemption from sales or use tax imposed by the state of Minnesota, enter 
       “MN” in the boxes provided. If you are claiming exemption for more than one member state, 
       complete the SSUTA Certificate of Exemption: Multistate Supplemental form.

2.     Single purchase exemption certificate: Check this box if this exemption certificate is being 
       used for a single purchase. Include the invoice or purchase order number for the transaction.

        If this box is not checked, this certificate will be treated as a blanket certificate.  A blanket 
        certificate continues in force so long as the purchaser is making recurring purchases (at least 
        one purchase within a period of twelve consecutive months) or until otherwise cancelled by the
        purchaser.

3.     Purchaser information: Complete the purchaser and seller information section, as requested.
       An identification number for you or your business must be included. Include your state tax 
       identification number and identify the state and/or country that issued the number to you. If you
       do not have a state tax identification number, enter the Federal Employers Identification 
       Number (FEIN) issued to your business, or if no FEIN number is required, enter your personal 
       driver’s license number and the state in which it is issued. Foreign diplomats and consular 
       personnel must enter the individual tax identification number shown on the sales tax exemption
       card issued to you by the United States Department of State’s Office of Foreign Missions. 

       Multistate Purchasers: The purchaser should enter its headquarters address as its business 
       address.

4. Type of business: Circle the number that best describes your business or organization. If 
   none of the categories apply, circle number 20 and provide a brief description.

5. Reason for exemption: Circle the exemption that applies to you or your business and enter 
   the additional information requested for that exemption. If the member state that is due tax on 
   your purchase does not require the additional information requested for the exemption reason 
   code circled, enter “NA” for not applicable on the appropriate line. New Jersey law does not 
   allow for the exemptions referenced in C, E and F. Therefore, those exemptions have been 
   stricken.

   Exemptions not listed: The New Jersey Division of Taxation issues pre-printed exemption 
   forms directly to taxpayers that qualify for exemption under UEZ (the Urban Enterprise Zone 
   program), BRRAG (Business Retention and Relocation Assistance Grant Program), or are 
   qualified Exempt Organizations. Your UZ-4, UZ- 5-SB, ST-4 (BRRAG), or ST-5 must be 
   supplied to claim exemption on these grounds.

   If some other exemption that is not listed applies, circle “L Other” and enter an explanation. 
   The explanation for “L Other” must include a clear and concise explanation of the reason for 
   the exemption claimed. Some more common exemptions that may be listed as explanation 
   could be: wrapping materials, research and development, commercial truck, etc.

   Multistate Purchasers: Attach the SSUTA Certificate of Exemption – Multistate Supplemental 
   Form and indicate the applicable reason for exemption and identification number (if required) 
   for each of the additional states in which the purchaser wishes to claim exemption from tax.

   CAUTION: The exemptions listed are general exemptions most commonly allowed by member
   states. However, each state’s laws governing exemptions are different. New Jersey law 
   provides for several exemptions that are not specifically named on this form. For general 
   information on the taxability of common goods and services, and the applicability of the sales 
   tax exemptions allowed under New Jersey law, see the Division’s website at:  
   www.state.nj.us/treasury/taxation.

   Seller: You are required to maintain proper records of exempt transactions and provide those 
   records to Member states of the SST Governing Board, Inc., when requested. These 
   certificates may be provided in paper or electronic format. If a paper exemption certificate is 
   not forwarded by the purchaser, but instead the data elements required on the form are 
   otherwise captured by the seller, the seller must maintain such data and make it available to 
   Member states in the form in which it is maintained by the seller.

You are relieved of the responsibility for collecting and remitting sales tax on the sale or sales for
which the purchaser provided you with this exemption certificate, even if it is ultimately determined
that the purchaser improperly claimed an exemption, provided all of the following conditions are met:

1. All fields on the exemption certificate are completed by the purchaser or the required 
   information is captured and maintained. (The reason code ID # in Section 5 is not required for 
   the exemption certificate to be fully completed.);

2. The fully completed exemption certificate (or the required information) is provided to you at the 
   time of sale or as otherwise provided by Section 317 of the SSUTA;

3. If the purchaser is claiming an entity-based exemption (i.e., an exemption based on who the 
   purchaser is) the state that would otherwise be due the tax on the sale allows the specific 
   entity-based exemption claimed by the purchaser if the purchase was made at a sale location 
   operated by the seller within that state;

4. If a business purchaser claims a multiple points of use exemption reason code (note that 
   effective dates for this exemption may vary by state) as provided under Section 312 of the 
   SSUTA, and the items being purchased are not tangible personal property other than computer
   software;

5. You do not fraudulently fail to collect the tax due; or

6. You do not solicit customers to unlawfully claim an exemption.