St5 Form – Fill Out and Use This PDF

Part 1, Exempt taxpayer information, is to be completed by exempt government or 501(c)(3) organization.

Enter the Name, the Address, the City State Zip and the Exemption number.

Enter the Issue date and the Date of expiration of certificate.

Certification is made that the organization named under Name is an exempt purchaser under Massachusetts General Laws, Chapter 64H, sections 6(d) or 6(e). All purchases of tangible personal property or services by this organization are exempt from taxation under said chapter to the extent that such property or services are used in the conduct of the business of the purchaser. Any abuse or misuse of this certificate by any tax-exempt organization or any unauthorized use of this certificate by any individual constitutes a serious violation and will lead to revocation.

Sign under Signature, and enter Title and Date.

Willful misuse of this certificate may result in criminal tax evasion sanctions of up to one year in prison and $10,000 ($50,000 for corporations) in fines. (checked November 8, 2026)

Part 2, Agent information, is to be completed by agent of exempt government or 501(c)(3) organization.

Enter the Name of agent's organization, the Address and the City State Zip.

Enter the Agent's name, the Address and the City State Zip.

Certify that in making this purchase, you are acting as an agent for the exempt organization named under Name (select one).

Government organization (local public school, city/town government, state agency, etc.): attach Form ST-2, if available. If Form ST-2 is not available, enter exemption number, if known. 501(c)(3) organization (parochial school, Scout troop, etc.): Form ST-2 must be attached.

Under Signature, sign, and enter the Title and the Date.

In Part 3, Vendor information, enter the Vendor's name.

Check applicable box: Single purchase certificate (attach detailed receipts or complete Part 4, on reverse) or Blanket certificate.

In Part 4, Description of property purchased, enter the Date, the Description, the Quantity and the Cost.

Enter the Total cost.

An exempt 501(c)(3) organization must have obtained a Certificate of Exemption (Form ST-2) from the Commissioner of Revenue certifying that it is entitled to exemption under G.L. c.64H, §6(e).

The exempt government organization is encouraged to submit to the vendor a properly completed Sales Tax Exempt Purchaser Certificate (Form ST-5) with a copy of its Form ST-2 attached.

The agent must complete Part 2 when acting on behalf of the exempt government organization.

If Part 1 is not completed by the exempt government organization, the agent must enter the name, address, and, if available, the exemption number of the government organization on whose behalf the purchases are being made.

Also enter a description of the property purchased into Part 4.

The agent of the exempt 501(c)(3) organization must complete Part 2 of Form ST-5.

Form ST-5 is the Sales Tax Exempt Purchaser Certificate of the Massachusetts Department of Revenue. This form is approved by the Commissioner of Revenue and may be reproduced.

The 501(c)(3) organization must submit to the vendor a properly completed Sales Tax Exempt Purchaser Certificate (Form ST-5) signed by the 501(c)(3) organization with a copy of its Form ST-2 attached.