Nebraska Form 17 – Fill Out and Use This PDF

In Section A, enter the Name, Street or Other Mailing Address, City, State and Zip Code under Name and Address of Contractor, and under Name and Address of Exempt Governmental Unit or Exempt Organization.

Under Name and Location of Project, enter the Name, Street Address, City, State and Zip Code; under Appointment Information, enter the Effective Date (See instructions), Expiration Date and Nebraska Exemption Number (Exempt Organizations Only).

Provide the contract name, number, and a description of the project.

Effective Date: Enter the date the appointment begins.

Regardless of the effective date entered, the appointment is effective on the later of the effective date or project owner's signature date.

Common mistake: Expiration Date: Enter the date the appointment ends. The phrase “upon completion” or similar phrase is not an acceptable expiration date.

The project owner must issue a new Form 17 if building materials will be annexed after the expiration date.

The undersigned governmental unit or exempt organization appoints the contractor and the contractor's delegated subcontractors as its agent to purchase and pay for building materials that will be annexed to real estate by them into the tax exempt construction project.

Sign here on the Authorized Signature of Exempt Governmental Unit or Exempt Organization line and enter the Title and Date.

Another individual may sign Section A or Section B if authorized by an attached power or attorney.

The project owner will give the original Form 17 to the contractor and retain a copy for its records.

Section B - Delegation of Contractor's or Subcontractor's Authority: A contractor or subcontractor can delegate its authority to its subcontractor.

Under Contractor's Delegation Information for the Project Identified in Section A, enter the Name and Address of Subcontractor (Name, Street or Other Mailing Address, City, State, Zip Code), the Effective Date, Expiration Date and Portion of Project.

Portion of Project: Describe the portion of the project that will be completed by the subcontractor.

Effective Date: Enter the date the delegation begins. Expiration Date: Enter the date the delegations ends.

The undersigned contractor hereby delegates authority to the subcontractor to act as the purchasing agent of the named governmental unit or exempt nonprofit organization. Sign here on the Signature of Contractor or Authorized Representative line and enter the Title and Date.

Section B must be signed by the owner, partner, or corporate officer of the contractor or subcontractor.

Under Subcontractor's Delegation Information for the Project Identified in Section A, enter the Name and Address of Subcontractor (Name, Street or Other Mailing Address, City, State, Zip Code), the Effective Date, Expiration Date and Portion of Project.

Sign here on the Signature of Subcontractor or Authorized Representative line and enter the Title and Date.

If the Form 17 is not timely issued, the Option 2 or Option 3 general contractor must pay the sales or use tax on all building materials annexed to real estate before the later of the effective date or signature date on the appointment.

On-Call, Repair, or Maintenance Agreements: Project owners are normally required to issue a separate Form 17 for each service call.

However, project owners may issue a Form 17 that covers all service calls for up to a full calendar year. This is available when the parties enter into a written agreement for on-call repairs, or maintenance. A new written agreement and Form 17 must be issued each calendar year.

The exemption under an appointment is limited to: the building materials that will be annexed to property that belongs or will belong to the project owner; the building materials annexed for the project listed in Section A; and the building materials annexed between the effective and expiration dates listed in Section A.

Delegation by a General Contractor: The contractor should complete Section B on a copy of the Form 17 it received from the project owner. The contractor must issue the Form 17 it completed to its subcontractor. A separate Form 17 must be issued by the contractor to each of its subcontractors.

Delegation by a Subcontractor: A subcontractor may delegate its purchasing agent authority to another subcontractor for all or a portion of their project by following these steps: Make a copy of the Form 17 received from the contractor or subcontractor that hired them and complete section B. Issue the Form 17 to the subcontractor to whom they are delegating their purchasing authority.

A nonprofit organization or educational institution is not exempt until it applies for and receives an Exempt Organization Certificate of Exemption issued by the Nebraska Department of Revenue (DOR).

Certain nonprofit organizations must be licensed or certified (licensed) with other state agencies (e.g., the Department of Health and Human Services or the Department of Education) and hold a certificate of exemption issued from the DOR before they are exempt from sales and use taxes. The exemption only applies to the facilities or activities covered under the license. The nonprofit organization cannot issue a Form 17 to its contractors for an unlicensed facility or activity.

After receiving its license and certificate of exemption, those nonprofit organizations may file a refund claim for any sales or use tax paid by them or their contractor.

Purchasing Building Materials Tax Exempt - Projects for Exempt Entities: Option 1 and Option 3 contractors must issue a properly completed Form 13 to its suppliers. An Option 1 or Option 3 contractor does not need to provide its suppliers with a Form 17.

An Option 2 contractor must issue its suppliers a properly completed Form 13, Section C, Block 2 and a copy of the Form 17 it received.

The project owner must issue a Form 17 to the contractor BEFORE the contractor annexes any building materials for the project.