Colorado Sales Tax Exemption Certificate Multi-Jurisdiction

Sales Tax Exemption Certificate Multi-Jurisdiction
Form DR 0563
DR 0563 (08/30/13)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261-0013

*130563==19999*

Sales Tax Exemption Certificate
Multi - Jurisdiction
See page 2 for instructions
Last Name or Business Name

First Name

Middle Initial

Address
City

State

ZIP

State

ZIP

I Certify That

Name of Firm (Buyer)
Address
City

Qualifies As (Check each applicable item)
Retailer
Manufacturer

Wholesaler

Political Subdivision or Governmental Agency

Charitable or Religious

Other (Specify)

If Other, specify here

1) and is registered with the below listed states and cities within which your firm would deliver purchases to us
which are for resale or lease by us in the normal course of our business which is

or

2) that such purchases are exempt from payment of sales or use tax in such states and cities because our buyer is:
Political Subdivision or Governmental Agency

Charitable or Religious

Otherwise Exempt By Statute (Specify)

If Otherwise Exempt By Statue, specify here
City or State

State Registration or ID Number

City or State

State Registration or ID Number

City or State

State Registration or ID Number

City or State

State Registration or ID Number

City or State

State Registration or ID Number

City or State

State Registration or ID Number

If the list of states and cities is more than six(6), attach a list to this certificate.
I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sale or
Use Tax we will pay the tax due direct to proper taxing authority when state law so provides or inform the seller for added
tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and
shall be called until canceled by us in writing or revoked by the city or state.
General Description of products to be purchased from seller

Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature (owner, Partner or Corporate Officer)

Title

Date (MM/DD/YY)

To Our Customers:
In order to comply with the majority of state and local sales
tax law requirements, it is necessary that we have in our
files a properly executed exemption certificate from all of our
customers who claim sales tax exemption. If we do not have
this certificate, we are obligated to collect the tax for the state
in which the property is delivered. If you are entitled to sales
tax exemption, please complete the certificate and send it to
us at your earliest convenience. If you purchase tax free for
a reason for which this form does not provide, please send
us your special certificate or statement.
*Lessor: A form DR0440, “Permit to Collect Sales Tax
on the Rental or Lease Basis” must be completed and
submitted to the Department of Revenue for approval.

Caution To Seller: In order for the certificate to be
accepted in good faith by the seller, the seller must exercise
care that the property being sold is of a type normally
sold wholesale, resold, leased, rented , or utilized as an
ingredient or component part of a product manufactured by
the buyer in the usual course of his business. A seller failing
to exercise due care could be held liable for the sales tax
due in some states or cities.
Misuse of this certificate by the seller, lessor, buyer, lessee, or the representative thereof may be punished by fine,
imprisonment or loss of right to issue certificates in some
states or cities.