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Indiana Free Printable  for 2024 Indiana Utility Sales Tax Exemption Application

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Utility Sales Tax Exemption Application
Form ST-200

Form ST-200 State Form 48843 (R13 / 1-23) Utility Sales Tax Exemption Application For Purchase of Metered Utility or Telecommunication Services Applicant must also complete the reverse side. A. Legal Address Legal Name Telephone Number Street/P.O. Box City, State, ZIP B. Meter Location Address DBA (doing business as) Name Telephone Number Street City, State, ZIP C. Billing Name (A copy of the utility bill with billing name must be attached.) Billing Name Franchise Name, if applicable □ 12 months of bills are attached □ This is a new meter □ One for one change D. Fill In All Applicable Blanks On the reverse side, all Applicants must complete section E; complete other sections as applicable. 1. Indiana Taxpayer Identification Number (TID) 2. Location (three digit location number) 3. Social Security Number (farmers only) 4. Federal ID Number 5. Name of Primary Utility Company 6. Meter Number (only 1 meter per application) 7. Account Number (from utility bills) 8. Name of Secondary Utility Company (if applicable) 9. Account Number 10. Type of Energy/Utility Service (telephone, gas, electric, steam, or water) 11. Average Monthly Bill 12. Annual K.W.H. Cubic Feet or Gallons (used in previous calendar year) 13. Total Hours of Operation per Day 14. Number of Operational Days per Week 15. Number of Operational Weeks per Year 16. What exemption percentage are you requesting? For Department Use Only Employee Name Exempt % Disposition User ID NAICS Code Issue ST-109 Date POA □ Yes □ No Audit Case Number □ Yes □ No E. Summary Please provide a brief overview of your operation. Explain how the utility is used. F. Supporting Schedule (See Instructions) Utility Usage Study: Production List all production and nonproduction equipment with the annual energy consumption with K.W.H., cubit feet, or gallons breakdown for each piece of equipment. G. Utility Usage Study: Research & Development (R&D) List all R&D and Non R&D equipment with annual energy consumption with K.W.H., cubit feet, or gallons breakdown for each piece of equipment. H. Certification/Signature I hereby certify under penalty of perjury that the foregoing is true and correct to the best of my knowledge, that all equipment has been listed, and that the power ratings of all listed equipment have been visually verified. _________________________ ________________________ __________________________ ______________ Authorized Signature Printed Name Email Date _________________________ ________________________ __________________________ ______________ Signature of Utility Study Printed Name Email Date Preparer Instructions for Completing Form ST-200 The information requested on the ST-200 enables the Indiana Department of Revenue (DOR) to verify the exempt status of metered utility or telecommunication services. With the submission of Form ST-200, your meter location address may be subject to an on-site inspection by DOR. Complete a separate application for each meter and/or telephone account. Fill in all blanks. Any applications that are missing information or incomplete will be rejected thus delaying the processing of your application. Note. The Utility Sales Tax Exemption Application can also be submitted electronically via DOR’s secure e-service portal INTIME at intime.dor.in.gov. If there are any changes in the manner in which the utility is used, changes in ownership of the business, or the addition or deletion of equipment connected to the meter (for water, gas, electricity, or steam), a new application will be required. Section A: Mailing Address. You must apply using the legal name of the business entity. Enclose a copy of the utility bill with the legal name to expedite the application review. Section B: Meter Location Address. Provide the location address of the meter or communication service. Section C: Billing Name. A complete copy of the utility billings with billing name, location, meter number and account number must be attached. If this information is not available on the bill, other documentation will need to be provided. For example, a screenshot of your online utility account or correspondence from the utility company on their letterhead with the information needed. Annual utility usages must be documented. Attach 12 months of billings. Section D: Fill in All Applicable Blanks. Complete all applicable information. Any missing information may delay the processing of your application. Section E: Summary. Explain how the utility is used. Example. For telephone service used in rendering public transportation, the supporting schedule may read 35% dispatch, 5% sales, 5% marketing, etc. Usage must total 100%. Section F: Utility Usage Study. Production is eligible for predominate use exemption. Businesses need to provide the following information detailing production and non-production equipment for the meter: (R&D skip to Section G) • List each piece of equipment connected to the meter (production and non-production equipment); • Explain how the equipment is used; • Provide the power rating of each piece of equipment; • List the number of hours the equipment is used; • Provide the total energy consumed for each piece of equipment for the previous calendar year. Section G: Utility Usage Study. Research and Development (R&D) is not eligible for predominate use exemption. Businesses need to provide the following information detailing the R&D and non-R&D equipment usage for the meter: • List each piece of equipment connected to the meter (R&D and non-R&D); • Explain how the equipment is used; • Provide the power rating of each piece of equipment; • List the number of hours the equipment is used; • Provide the total energy consumed for each piece of equipment for the previous calendar year. Section H. Certification/Signature. Sign and date the application. If you are a representative, a Form POA-1 must be attached. If submitting via DOR’s secure e-service portal INTIME, an electronic POA (ePOA) must be completed. The person who completed the utility study must sign and date the form. Return the application to: Indiana Department of Revenue P.O. Box 935 Indianapolis, IN 46206-0935 For assistance, contact DOR directly via INTIME messaging at intime.dor.in.gov by selecting “Send a message” under the “All Actions” tab. Or call customer service at 317-232-2240.
Extracted from PDF file 2023-indiana-form-st-200.pdf, last modified August 2023

More about the Indiana Form ST-200 Sales Tax TY 2023

We last updated the Utility Sales Tax Exemption Application in February 2024, so this is the latest version of Form ST-200, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form ST-200 directly from TaxFormFinder. You can print other Indiana tax forms here.

Other Indiana Sales Tax Forms:

TaxFormFinder has an additional 69 Indiana income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form ST-105 Indiana General Sales Tax Exemption Certificate
Form NP-20A Nonprofit Application for Sales Tax Exemption
Form ST-103 Instructions Sales and Use Tax Voucher Instructions
Form ST-108 Certificate of Gross Retail or Use Tax Paid
Form ST-200 Utility Sales Tax Exemption Application

Download all IN tax forms View all 70 Indiana Income Tax Forms


Form Sources:

Indiana usually releases forms for the current tax year between January and April. We last updated Indiana Form ST-200 from the Department of Revenue in February 2024.

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About the Sales Tax

Sales taxes are applied to the transfer of goods (and sometimes services) to the end consumer in most of the fifty states, and are collected by the vendor from their customers and remitted to the state taxation department on a regular basis. Therefore, most sales tax related tax forms are applicable to businesses, and not private individuals.

Historical Past-Year Versions of Indiana Form ST-200

We have a total of four past-year versions of Form ST-200 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:



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