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DR 0172 (01/17/23)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261 - 0009
*DO=NOT=SEND* (303) 238-SERV (7378)

Special Notice

Purpose of this application F Attach a copy of the contract or agreement page,
identifying the contracting parties, bid amount, type
The exemption certificate for which you are applying must
of work performed. This must include the signature
be used only for the purpose of purchasing construction
of the Exempt Organization.
and building materials for the exempt project described
below. This exemption does not include or apply to the F Bid amount on Contract or Agreement page
purchase or rental of equipment, supplies, and materials matches the amount listed on the application (to the
which are purchased, rented, or consumed by the penny)
contractor and which do not become a part of the structure, F The exempt organization’s 98 number was provided
highway, road, street, or other public works owned and and is correct.
used by the exempt organization.
F Ensure the completion dates listed on the
Any unauthorized use of the exemption certificate will application can be validated by your contract, award
result in revocation of your exemption certificate and other letter, agreement or purchase order.
penalties provided by law.
F Sign the DR 0172 (Contractor Application for
A separate certificate is required for each project. Exemption Certificate).
See FYI Sales 95 for information about qualifying affordable
Subcontractors:
housing projects.
Subcontractors will not be issued Certificates of Exemption
by the Department of Revenue. Upon receipt of the Exemptions Mailbox
Certificate, the prime contractor should make a copy for dor_exemptionapplications@state.co.us
each subcontractor involved in the project and complete
it by filling in the subcontractor's name and address and
Purpose
signing it. The original Certificate should always be retained
by the prime contractor. Copies of all Certificates that the Use this mailbox to submit new applications or provide
prime contractor issued to subcontractors should be kept at missing information for an existing application. Emails
the prime contractor's place of business for a minimum of inquiring about a status or requesting copies of approved
three years and be available for inspection in the event of certificates will not receive a response.
an audit.
New Submissions
Application Requirements (Checklist) A separate application is required for each project. Multiple
applications are allowed and can be submitted in one
Prevent your application from being returned. email if they are added as separate attachments. Copies of
F Read the Special Notice approved certificates will not be issued from this mailbox. In
F Complete an application for each project. the subject line list the word Encrypt.

F Accurately complete all applicable fields. (Read
Existing applications
Instructions)
Include a copy of the notice received along with the missing
information. In the subject line list the word Encrypt.

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DR 0172 (01/17/23)
COLORADO DEPARTMENT OF REVENUE
Denver CO 80261 - 0009
*DO=NOT=SEND* (303) 238-SERV (7378)

Form Instructions
Accurately complete all applicable fields. Additional information for specific fields is available below.
Contractor Information: Attachment Required
Colorado Withholding Account Number Contract (agreement, purchase order, award letter)
A Colorado Account Number (CAN) should be provided in Each application must include a copy of the contract or
this field. If your company does not have a (CAN) review agreement to include the following information:
the options listed below. Applications that are left blank or ● The type and scope of work
list N/A will not be processed.
● Bid amount (the same amount to the penny should
Subsidiary: be listed on your application)
This box is marked when a subsidiary is using the parent's
●
withholding account number (only when it does not have its Project start and estimated completion dates.
own.) Provide the parents CAN. ● Is signed by contracting parties involved in the
Subcontractor: project including the exempt organization.
This box is marked when a contractor does not have Exemption Information:
employees of their own and outsources their employees
through a subcontractor. List the subcontractor or Exempt Organization’s Number
subcontractors name and CAN(s). An exempt organization’s Colorado exemption account
number will begin with a “98”.
Staffing Agency:
This box is marked when a contractor does not have Contact the exempt organization to obtain or verify this
employees of their own and outsources their employees information prior to submitting your application.
through a staffing agency. Provide the Staffing Agency’s Failure to provide this number will cause your application to
name and CAN. be rejected.
No employees/no subcontractors Scheduled Construction Start and Estimated
For contractors with no employees, no subcontractors/ Completion Dates
staffing agencies: Enter the start and completion dates in these fields.
Ensure the completion dates listed on the application can
Write no employees in the (CAN) box and provide an
be validated by your contract, award letter, agreement or
explanation. For example, I have no employees or
purchase order.
subcontractors and perform all of the work myself.

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                                                              DR 0172 (01/17/23)
                                                              COLORADO DEPARTMENT OF REVENUE
                                                              Denver CO 80261 - 0009
*140172==19999*                                               Tax.Colorado.gov
                                                              Page 1 of 1
                Contractor Application for Exemption Certificate
This exemption does not include or apply to the purchase                 Any unauthorized use of the exemption certificate will 
or rental of equipment, supplies, and materials which are                result in revocation of your exemption certificate and other 
purchased, rented, or consumed by the contractor and                     penalties provided by law.
which do not become a part of the structure, highway,                    A separate certificate is required for each project.
road, street, or other public works owned and used by the 
exempt organization.
Fax completed forms and contracts to 303-205-2376 or mail to: Colorado Department of Revenue, Denver, CO 80261-0009
Email completed forms and contracts to DOR_Exemptionapplications@state.co.us (see instructions)
Failure to accurately complete all boxes of the form or provide all supporting documentation will cause the 
application to be denied.
                                                   Must be completed by applicant
Contractor Information
Trade name/DBA

Owner, partner or corporate last name                          First Name                                                          Middle Initial

Mailing Address                                    City                                                       State             ZIP

E-Mail Address                                                 FEIN                        Bid amount for your contract (Must match to the penny)
                                                                                           $
Fax number                                                               Business Phone number

Colorado withholding tax account number 

If your company does not have a Colorado withholding tax account number check the option below that applies (See instructions)
 Subsidiary          Subcontractors                            Staffing Agency             No employees/subcontractors (see below)
No Employees/Subcontractors. (Provide explanation or attach a letter of explanation).

Exemption Information 
                                    Copies of contract or agreement page, identifying the contracting parties, bid amount, type 
**Attachment Required**             of work, and signatures of contracting parties must be attached
Name of exempt organization (as show on contract)                                          Exempt organization's number (See instructions)
                                                                                           98
Address of exempt organization                     City                                                       State             ZIP

Principal contact at exempt organization-Last Name             First Name                                                          Middle Initial

Housing Authority (if applicable)                                        Name of Project (if applicable)

Owner of the Project (if applicable)

Physical location of project site (give actual address when applicable and Cities and/or County(ies) where project is located)

City                                                                            State ZIP               Principal contact's telephone number

Scheduled construction start date (MM/DD/YY)                             Estimated completion date (MM/DD/YY) (See instructions)

I declare under penalty of perjury in the second degree that the statements made in this application are true and complete to the best 
of my knowledge.
Signature of the business owner, partner or corporate officer  Title of corporate officer                                     Date (MM/DD/YY)

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