St 119 1 Form Exempt – Fill Out and Use This PDF

NEW YORK EXEMPT PURCHASE CERTIFICATE (FORM ST 119.1)

***For internal Indiana University use only***

NOTE: According to New York, Section 1116(a)(4), Indiana University is exempt from sales and use tax because it is organized exclusively for educational purposes. The University must issue the attached certificate to vendors when purchasing tangible personal property or taxable services to qualify for the exemption. A vendor may accept Form ST 119.1 from Indiana University at the time of sale, or within 90 days of accepting delivery of the property or the rendering of services.

•Indiana University must be the direct purchaser and payer of record. Purchases must be made in the following manner:

O Are directly invoiced and charged to Indiana University, and O Are directly paid by Indiana University via

check,

credit card

•All purchases made using Form ST 119.1 must benefit the University only. The form may not be used for the benefit of any officer, member, or employee of Indiana University.

•The exemption does not apply to purchases of motor fuel or diesel motor fuel.

•It is not necessary to give the seller a new certificate every time a purchase is made. A blanket exemption claim covers all exempt transfers between the University and the vendor for a three year period from the date of purchase.

INSTRUCTIONS: Fill out all sections highlighted in blue including:

•Seller’s Name and Address

•The exemption certificate must have the original signature of a responsible officer. Indiana University has designated Associate Vice President & Director of Procurement Services, Jill Schunk, as the signatory. Please e-mail Jill Schunk for an appointment.

T he exempt organization must be the direct purchaser and payer of record.

You may not use this form to purchase motor fuel or diesel motor fuel exempt from tax.

Representatives of governmental agencies or diplomatic missions may not use this form.

Carefully read the instructions and other information on the back of this document.

I certify that the organization named above holds a valid Form ST-119 , Exempt Organization Certificate, and is exempt from New York State and local sales and use taxes on its purchases.

Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted . I make these statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evade any such tax may constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentence. I understand that this document is required to be filed with , and delivered to the vendor as agent for the Tax Department for the purposes of section1838 of the Tax Law and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. I also understand that the Tax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document.