DR 1240 (07/15/21)
COLORADO DEPARTMENT OF REVENUE
Field Audit Section
PO Box 17087
Denver CO 80217-0087
Tax.Colorado.gov

                    Certification for Sales Tax Exemption on
                              Pine or Spruce Beetle Wood

                                             Instructions
Wholesalers  should  complete  and  sign  this  form  for  all  A copy of the signed certification form should be sent to the 
products that will be sold in Colorado made from mountain  Colorado Department of Revenue Field Audit section at the 
pine or spruce beetle-infested wood harvested in Colorado.       following address:

A copy of the signed certification form should be provided                         Colorado Department of Revenue
to each retailer that buys the product for resale in Colorado.                     Field Audit Section
The  retailer  should  retain  this  copy  along  with  invoices                   PO Box 17087
showing purchases of the product for resale.                                       Denver, CO 80217-0087

I(we) affirm that the product(s) listed in this document qualify for the Colorado sales tax exemption for wood salvaged 
from trees infested in Colorado by mountain pine or spruce beetles.

I(we) affirm that the supplier/manufacturer of product(s) listed in this document has made the product(s) using wood 
salvaged from trees infested in Colorado by mountain pine or spruce beetles.

I(we) understand the instructions for use of this form.

                                             Please Print or Type
Colorado source of beetle-infested wood products (supplier or manufacturer name)   Supplier Colorado Account Number

Wholesaler Name                                                                    Wholesaler Colorado Account Number

Wholesaler Address                                                                 Wholesaler Business Phone

City                                                             State             ZIP Code

Product(s)

Signature                                                                          Date