Massachusetts Sales Tax Exempt Purchaser Certificate

Sales Tax Exempt Purchaser Certificate 
ST-5
Rev. 6/09

Form ST-5
Sales Tax Exempt
Purchaser Certificate
Part 1. Exempt taxpayer information.

Massachusetts
Department of
Revenue

To be completed by exempt government or 501(c)(3) organization.

Name

Address

City

State

Zip

Exemption number

Issue date

Date of expiration of certificate

Certification is hereby made that the organization named above is an exempt purchaser under Massachusetts General Laws, Chapter 64H, sections 6(d)
or 6(e). All purchases of tangible personal property or services by this organization are exempt from taxation under said chapter to the extent that such
property or services are used in the conduct of the business of the purchaser. Any abuse or misuse of this certificate by any tax-exempt organization or
any unauthorized use of this certificate by any individual constitutes a serious violation and will lead to revocation.
Signature

Title

Date

Warning: Willful misuse of this certificate may result in criminal tax evasion sanctions of up to one year in prison and $10,000 ($50,000 for
corporations) in fines.

Part 2. Agent information.

To be completed by agent of exempt government or 501(c)(3) organization.

Name of agent’s organization

Address

City

State

Zip

State

Zip

Agent’s name

Address

City

I certify that in making this purchase, I am acting as an agent for the exempt organization named above (select one):
Government organization (local public school, city/town government, state agency, etc.).
Attach Form ST-2, if available. If Form ST-2 is not available, enter exemption number, if known:
501(c)(3) organization (parochial school, Scout troop, etc.). Form ST-2 must be attached.
Signature

Title

Date

Part 3. Vendor information
Vendor’s name

Check applicable box:
Single purchase certificate (attach detailed receipts or complete Part 4, on reverse)
Blanket certificate

This form is approved by the Commissioner of Revenue and may be reproduced.

Part 4. Description of property purchased
Date

Description

Quantity

Cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

Total cost

$

General information
An exempt 501(c)(3) organization must have obtained a Certificate of Exemption (Form ST-2) from the Commissioner of Revenue certifying that it is
entitled to exemption under G.L. c.64H, §6(e). The 501(c)(3) organization
must submit to the vendor a properly completed Sales Tax Exempt Purchaser Certificate (Form ST-5) signed by the 501(c)(3) organization with a
copy of its Form ST-2 attached.
Any person, group or organization purchasing as an agent on behalf of a
501(c)(3) organization must certify that it is doing so by presenting to the
vendor a properly completed Form ST-5 signed by the 501(c)(3) organization. It must also present a copy of the 501(c)(3) organization’s Form ST-2.
The agent of the exempt 501(c)(3) organization must complete Part 2 of
Form ST-5.
Any government organization is encouraged to obtain a Certificate of Exemption (Form ST-2) from the Commissioner of Revenue, certifying that it
is entitled to exemption under G.L. c.64, § 6(d). The exempt government
organization is encouraged to submit to the vendor a properly completed
Sales Tax Exempt Purchaser Certificate (Form ST-5) with a copy of its
Form ST-2 attached. If the government organization does not present Form
ST-5, the vendor must maintain adequate documentation (generally, a copy
of the government check) verifying that the purchaser is an exempt government agency.
Any person, group or organization purchasing on behalf of exempt government organizations must certify that they are doing so by presenting to the
vendor a properly executed Form ST-5 when making such purchases. Part

1 of Form ST-5 should be filled out by the exempt government organization. If Part 1 is not completed by the exempt government organization, the
agent must enter the name, address, and, if available, the exemption number of the government organization on whose behalf the purchases are being made. Also enter a description of the property purchased into Part 4.
The agent must complete Part 2 when acting on behalf of the exempt government organization. The purchaser must attach to the Form ST-5 a copy
of the exempt government organization’s Form ST-2 if available. If it is not
available, the purchaser must enter the exemption number of the exempt
government organization.

Other information for vendors
Vendors should verify the validity of the certificate presented to them by
checking the expiration date on the certificate. Vendors must not honor a
Certificate of Exemption that has expired.
Government organization maintain Form ST-2 Certificates of Exemption that
have an expiration date of “None.”
Vendors should call the Customer Service Bureau at (617) 887-6367 if they
have any questions regarding a Certificate of Exemption which is presented
to them.
If you have any questions about completing this certificate, please contact:
Massachusetts Department of Revenue, Customer Service Bureau,
200 Arlington Street, Chelsea, MA 02150; (617) 887-6367.