Important—Certicate not
valid unless completed.
RESALE CERTIFICATE
Check Applicable Block
Blanket
Single Purchase
Name of Business Address
CAUTION TO SELLER: Contractors or other persons registered under a consumer number in the 900,000 series may not issue a resale
certicate for any purchase. Sellers accepting certicates from such persons will be held liable for the sales or use tax.
NOTE: Any person who makes improper use of this certicate is subject to such penalties as provided by law including the criminal
provisions of KRS 139.990(1).
Authorized Signature (Owner, Partner or Corporate Ofcer) Title
Date
I hereby certify that _______________________________________________________________________________
holds a valid Sales and Use Tax Permit, Account No. _______________, issued pursuant to the sales and use tax law and is
engaged in the business of selling, leasing or renting, industrial processing or manufacturing the following:
__________________________________________________________________________________________________
I further certify that the tangible personal property, digital property, or (effective on or after 7/1/2019) taxable services
enumerated in KRS 139.200(g)-(q) described herein which I shall purchase from:
_____________________________________________________________________________________________________________
will be resold in the regular course of business, or leased or rented, as provided by Regulation 103 KAR 28:051, or used, as
provided in KRS 139.470(9), in the manufacture or industrial processing of tangible personal property or digital property which
will be resold. In the event any property or service purchased under this certicate is used for any purpose other than retention,
demonstration or display while holding it for sale, lease or rental in the regular course of business, it is understood that I am
required by law to report and pay the tax measured by the purchase price of such product. Description of product to be purchased:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Under penalties of perjury, I swear or afrm that the information on this certicate is true and correct as to every material matter.
Name of Seller Address
DEPARTMENT OF REVENUE
Frankfort, Kentucky 40620
51A105 (7-19)