Wyoming Sales Tax Exemption Certificate, ETS Form 101

Fill in Issued to (Seller), Date Issued, Street Address, City, State and Zip Code.

Wyoming or Out of State Vendors: enter the sales/use tax license/registration number.

Fill in My principal business or activity is.

Place an X in applicable box or boxes for the reason you claim an exemption.

Purchase For Resale: 1. Purchases made for resale or taxable services for resale. (Licensed vendors only.)

All purchases of tangible personal property or taxable services which are to be re-sold and/or held in the vendor's inventory pending sale are purchases for resale if you are a licensed wholesale or retail vendor.

Check Box 2 if purchasing any tractor or other machinery designed or adapted and used exclusively for agricultural operations.

Check Box 3 if the livestock purchase is to be used for resale or breeding.

Check Box 4 if power or fuel is used directly in agriculture, for example, power to operate irrigation pumps, run milking machines, diesel used in tractors, mowers, and similar farm or ranch machinery used only for the operation of farm or ranch equipment.

Check Box 5 if the purchase of feed is to be used in the commercial feeding of livestock which are to be sold or for the purchase of seeds, roots, bulbs, small plants, and fertilizer to be applied to the earth for commercial crop growing.

6. Purchase of rolling stock including locomotives purchased by interstate railroads, aircraft purchased by interstate air carriers which are holders of valid United States Civil Aeronautics Board permits or authorities, and trucks, truck tractors, trailers, semitrailers, and passenger buses in excess of ten thousand (10,000) pounds gross vehicle weight which are purchased by common or contract carriers or which are operating in interstate commerce under exemption clauses in federal law if they are to be used in interstate commerce.

For Box 6, purchaser must provide a copy of the Interstate Commerce permit or certificate that was received from the Federal Government identifying the purchaser's U.S. DOT number and/or M.C. number, and a copy of a document verifying current insurance coverage.

Check Box 7 if the tangible personal property is necessarily used or consumed in manufacturing, processing and the property becomes an ingredient or component of the final property or if purchase is for containers, labels, or shipping cases used for tangible personal property manufactured or processed.

Check Box 8 if purchase is for power or fuel used in the business of manufacturing or processing when the same is consumed directly in manufacturing or processing and must be metered, stored, or separately accounted for to distinguish it from non-exempt power and fuel.

Check Box 9 if purchase is made by a Wyoming manufacturer classified by the department under the NAICS code manufacturing sector 31-33.

Check Box 10 if purchase of power or fuel is made by a person engaged in the business of transportation when the power or fuel is used in generating motive power for actual transportation purposes.

Check Box 11 if purchase of fuel is for use as boiler fuel in the production of electricity.

Boxes 12.* and 13.* are marked with an asterisk: all exemptions marked with an asterisk requires prior approval from the Department of Revenue before taking this exemption.

Evidence of prior approval is a Department of Revenue letter of authority.

Check Box 12 if purchase is made by a religious or charitable organization. Check Box 13 if purchase is made by a non-profit organization providing meals or services to senior citizens. Purchaser must present a letter of authority issued by the Department prior to making exempt purchases.

Check Box 14 if purchase is made by the United States Government.

Check Box 15 if purchase is made by the State of Wyoming or its political subdivisions such as Counties, Cities, Towns, or Municipalities.

Check Box 16 if purchase is made by a Wyoming Joint Apprenticeship Training Programs.

Check Box 17 if purchase is made by a Wyoming Joint Powers Board.

Check Box 18 if purchase is made by an Irrigation District created under W.S. 41-7-201 through W.S. 41-7-210.

Check Box 19 if purchase is made by a Weed and Pest District.

Purchases made by Native Americans who live on the Wind River Indian Reservation and are enrolled members of one of the two tribes residing on the Wind River Indian Reservation are exempt the payment of sales tax if purchases are made on the Wind River Indian Reservation.

Note: Purchases made by Native Americans off the Wind River Reservation are taxable.

Purchases of noncapitalized equipment and disposal supplies used in the direct care of patients by dentists or Medicare recognized health providers.

Specify the type of exemption you are claiming in Other: Specify if it is not mentioned in the exemptions listed in the other boxes.

Fill in Name of Purchaser, Street Address, City, State, Zip Code, Title, and the Signature of Owner, Partner, Officer of Corporation, etc.

I will pay sales or use tax on all tangible personal property used or consumed in a taxable manner.

In addition, I understand that I will be liable for the tax due, plus substantial penalty and interest for any erroneous or false use of this certificate.

Purchasers shall file a single exemption certificate with each selling vendor for exempt purchases.