Form E 595Ea – Fill Out and Use This PDF

E-595EA	Application for Exemption Number
Web-Fill	for Qualiied Purchases
2-11		Ofice Use
	North Carolina Department of Revenue
1. If Corporation, Partnership, or LLC	If Proprietorship then enter
enter Federal Employer ID No.:	Social Security Number:

2. Type of Ownership: Proprietorship Corporation Partnership LLC Other (Identify)

3.Owner’s Legal Name:

4.Trade Name (DBA Name):

5.

Street Address:

Street

(Not P.O. Box Number)

City

State

Zip Code

County

6.

Mailing Address:

Street or P.O. Box

City

State

Zip Code

7.

Type of Business or Profession:

Farmer

Commercial Fisherman

Commercial Logger

Veterinarian

8.Dollar amount of annual income from business or professional activities:

Check if just started within the year.

Check if just moved to North Carolina.

9.Describe the type of items sold and/or produced or services rendered:

Signature:

Date:

I certify that, to the best of my knowledge, this application is accurate and complete.

Name (Print):			Title:
E-mail:			Phone:

Mail to: N.C. Department of Revenue, Exceptions\Registration P. O. Box 25000, Raleigh, NC 27640-0001

Page 2

•Pursuant to G.S. 105-164.28A, the Secretary of Revenue may require a person who purchases tangible personal property that is exempt from sales or use tax or is subject to a preferential rate of tax to obtain an exemption certiicate from the Department to receive the exemption or preferential rate. Use this application to obtain an exemption number from the Department.

•A seller who receives a properly completed exemption certiicate bearing a valid exemption number is authorized to collect tax at the preferential rate or not collect tax, as appropriate.

•A person who purchases tangible personal property under an exemption certiicate is liable for any tax due and applicable penalties and interest if the Department determines that the person is not eligible for the exemption or the property was not used as intended. In addition, under the provisions of G.S. 105-236(7), any person who willfully attempts, or who aids or abets any person to attempt, in any manner to evade or defeat any tax imposed by law, or the payment of the tax, is guilty of a Class I felony. Punishment for this offense may include a ine up to $25,000. For each misuse of an exemption certiicate by a purchaser, the Secretary must assess against the purchaser an additional tax, as a penalty, of $250.

•An exemption number is required to be obtained by farmers, commercial ishermen, commercial loggers, and veterinarians that are not registered with the Department for sales and use tax purposes.

•The term “farmer” includes dairy operators, poultry farmers, egg producers, farmers who raise ish or water plants, livestock farmers, crop farmers, nurserymen, greenhouse operators, orchardmen, and other persons coming within the generally accepted deinition of the word. It does not include a person who merely cultivates a garden for personal use. The term “commercial” means held or produced for income or proit. For purposes of the exemption for sales to commercial ishermen, the term “commercial ishing operations” means all operations preparatory to, during, and subsequent to the taking of all marine mammals, all shellish, all crustaceans and all other ishes with the use of commercial ishing equipment or by any means, if a primary purpose of taking is to sell the ish.

•If you have questions, you may contact the NC Department of Revenue, P.O. Box 25000, Raleigh, North Carolina 27640-0001. You may also telephone the Taxpayer Assistance and Collection Center at 1-877-252-3052

(toll-free).

Line by Line Instructions

Line 1 - Exemption numbers are issued by FEIN or SSN. A separate application must be completed for each

FEIN or SSN.

Line 2 - Enter the type of ownership.

Line 3 - Enter your Legal Name for which an exemption number is requested.

Line 4 - Enter the Trade Name (Doing Business As Name) for which an exemption number is requested. Line 5 - Enter your business address in North Carolina.

Line 6 - Enter the mailing address to which all correspondence concerning the exemption number should be

mailed.

Line 7 - Enter your type of business or profession.

Line 8 - Enter an estimate of all your annual income from business or professional activities made by you. Check box if just started within the year. Check box if just moved to North Carolina.

Line 9 - Describe the type of items sold and/or produced or services rendered by you.

Sign and date the application. Print your name along with your title, phone number, and e-mail address where you can be reached if we have questions about your application. Mail your application to the NC Department of

Revenue, Exceptions\Registration, P.O. Box 25000, Raleigh, NC 27640-0001. Fax Number 919-715-2999.