Mississippi Temporary Storage Affidavit​​​ (Sales Tax Exemption)

Temporary Storage Affidavit​​​ (Sales Tax Exemption)
Ed Buelow, Jr
AFFIDAVIT OF TEMPORARY STORAGE
Form 72-16-01

STATE OF MISSISSIPPI, COUNTY OF ___________________________________________________ BEFORE ME, the
undersigned authority, on this day personally appeared __________________________________________________, who after being
(NAME)

by me first duly sworn, on oath deposed and said:
Under the penalty of perjury,
I hereby certify that I am temporarily storing tangible personal property in this state pending shipping or mailing of the property
outside this state. ___________ percent of the goods stored will be shipped out of state.
This percentage is based on:
Prior year’s shipments
Reasonable estimate
I understand that sales tax is due on any goods to be shipped within this state. I understand and agree that if the temporary
storage does not meet the requirement for exemption, I will be responsible for paying to the Mississippi Department of Revenue
the full seven percent (7%) retail rate, a fifty percent (50%) fraud penalty and the applicable rate of interest per month provided
in Miss. Code Ann. Section 27-65-39, from the date of taxable storage activity until the tax is paid to the Mississippi Department
of Revenue.
THIS AFFIDAVIT WILL ONLY SUPPORT THE EXEMPTION OF SALES TAX ON TEMPORARY STORAGE OF
TANGIBLE PERSONAL PROPERTY IN THIS STATE PENDING SHIPPING OR MAILING OF THE PROPERTY
OUTSIDE THIS STATE THROUGH DECEMBER 31, _________. I understand the temporary storage of tangible personal
property after December 31, of the current year will require a new affidavit.
WITNESS MY SIGNATURE, this the ______ day of _________________, 20____.
_________________________________________________

______________________________________________

(PRINTED NAME)

(SIGNATURE)

___________________________________________________________________________________________________
(STREET ADDRESS)

___________________________________________________________________________________________________
(MAILING ADDRESS)

Telephone Numbers: Work – (___) _______________

Home - (___) _________________

______________________________________________________________________________________________________________________________

NOTARY PUBLIC ACKNOWLEDGEMENT
STATE OF MISSISSIPPI, COUNTY OF ________________________
Personally came and appeared before me, the undersigned authority in and for the said county and state, on this ________ day of
__________________, 20____, within my jurisdiction, the within named _______________________________, who acknowledged
that he/she is the ___________________________ of __________________________________________________ and that in said
(TITLE)

(BUSINESS)

representative capacity he/she executed the above and foregoing instrument after having been duly authorized so to do.
Printed Name: _____________________________________
[ Place Seal Here ]

Signature: _____________________________________
My Commission Expires: _____________________________________

P.O. Box 1033,

Jackson, MS 39215

www.dor.ms.gov

Phone: 601.923.7015

FAX: 601.923.7034