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     Illinois Department of Revenue 

     EZ-1 Certificate of Exempt Purchase for Building Materials
     Use of this form requires the purchaser to have a valid Building Materials Exemption Certificate from the Illinois Department of Revenue. 

Step 1:   Identify the seller 
The seller must keep this certificate. 
Name _______________________________________________                                         Address __________________________________________ 
                                                                                                       Number and street 
Phone   (_______)______________________________________                                      ________________________________________________ 
                                                                                              City                                                                      State ZIP 

Step 2:        Identify the purchaser and purchaser’s certificate number                                          
Name _______________________________________________                                         Phone    (_______)___________________________________ 
Address _____________________________________________                                        Date of purchase    ___ ___/___ ___/___ ___ ___ ___
        Number and street                                                                                        Month                                          Day     Year 
___________________________________________________                                          Purchaser’s Building Materials Exemption Certificate Number: 
City                                              State                     ZIP 
                                                                                             ________________________________________________  

Step 3:   Location or address of the real estate into which building materials will be
               permanently incorporated 

Name of Zone or High Impact / REV / MICRO Business __________________________________________________________ 

Project Name _____________________________________________________________________________________ 
 
Location _____________________________________________                                        Address ________________________________________  
                                                                                                            Number and street                                            
                                                                                OR 
___________________________________________________                                            ______________________________________________ 
                                                                                               City                                                              State  ZIP 

Step 4:        Identify the building materials you are purchasing                                       

Description of building materials purchased                   ____________________________________________________________________ 
___________________________________________________________________________________________________________ 
___________________________________________________________________________________________________________ 
___________________________________________________________________________________________________________ 
___________________________________________________________________________________________________________ 
___________________________________________________________________________________________________________ 

Step 5:        Sign below         
I certify that the building materials described above are being purchased for incorporation into the real estate at the 
address or location indicated above. 

___________________________________________________________________________________   __ __/__ __/__ __ __ __
Purchaser’s signature                                                                                                                                                   Date 
For more information about Building Materials Exemptions, visit the Illinois Department of Revenue’s (IDOR) website at tax.illinois.gov. 
Select the “Businesses” link under the “Tax Resources” drop-down menu on the homepage and then select the “Business Incentives 
Reporting” quick link. 
Note to seller:      It   is the seller’s responsibility   to verify that   the purchaser’s  building materials  exemption certificate number      isvalid and active.              
You can confirm this by using the “Verify the validity of a Building Material Exemption Certificate” tool on our website at tax.illinois.gov. 
EZ-1 (R-04/23)                                    This form is authorized by the Illinois Retailers’ Occupation Tax Act.  Disclosure of this information is required.  
Printed by the authority of the state of Illinois Failure to provide information may result in this form not being processed and may result in a penalty.              *14604231W*
one copy, electronic only                                                                                                                                                          

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