Ct Cert 100 Form – Fill Out and Use This PDF

Department of Revenue Services

State of Connecticut

25 Sigourney Street

Hartford CT 06106-5032

(Rev. 01/05)

CERT-100

General Purpose: The purchaser of materials, tools, and fuel uses this certificate to establish that the item(s) being purchased will be used directly in:

•An industrial manufacturing plant in the actual fabrication of a product to be sold;

•Furnishing power to an industrial manufacturing plant; or

•Furnishing gas, water, steam, or electricity when delivered to consumers through mains, lines, pipes, or bottles.

Whether or not the materials, tools, and fuel will be used in Connecticut, charges for those materials, tools, and fuel when used as indicated above are not subject to sales and use taxes.

If the materials, tools, or fuel are not used in the manner described above, a purchaser who claimed an exemption owes use tax on the total price of any items purchased under this exemption.

Statutory Authority: Conn. Gen. Stat. §12-412(18); Conn. Agencies Regs. §12-412(18)-1.

Instructions for the Purchaser: An owner or officer of a business purchasing materials, tools, or fuel for use in the manner described above can sign and issue this certificate to advise the seller of these items that the purchase is exempt. Issue this certificate only for materials, tools, or fuel, as defined in Conn. Agencies Regs. §12-412(18)-1. Keep a copy of the certificate and records that substantiate the information entered on this certificate for at least six years from the date it is issued. If you do not have a Connecticut tax registration number, enter the tax registration number assigned by another state and identify the state.

Instructions for the Seller: Acceptance of this certificate, when properly completed, relieves the seller from the burden of proving that the sale and storage, use, or other consumption, of the materials, tools, or fuel is not subject to sales and use taxes. The certificate is valid only if taken in good faith from a person who is purchasing materials, tools, or fuel for use in the actual fabrication of finished products to be sold, in furnishing power to an industrial manufacturing plant, or in furnishing gas, water, steam, or electricity to consumers through mains, lines, pipes, or bottles. For example, the good faith of the seller will be questioned if the seller knows of facts that suggest the purchaser is not engaged in fabrication or that the materials, tools, or fuel will not be used directly in actual fabrication of finished products to be sold. Keep this certificate and bills or invoices to the purchaser for at least six years from the date of the purchase. The bills, invoices, or records covering all purchases made under this certificate must be marked to indicate this was an exempt purchase. The words “Exempt under CERT-100” satisfy the requirement.

This certificate can be used for individual exempt purchases, in which event the purchaser must check the box marked “Certificate for One Purchase Only.” The certificate can also be used for a continuing line of exempt purchases, in which event the purchaser must check the box marked “Blanket Certificate.” A blanket certificate remains in effect for a three-year period unless the purchaser revokes it in writing before the period expires.

For More Information: Call Taxpayer Services at 1-800-382-9463 (in-state) or 860-297-5962 (from anywhere). TTY, TDD, and Text Telephone users only may transmit inquiries anytime by calling 860-297-4911. Preview and download forms and publications from the DRS Web site at

www.ct.gov/DRS