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DR 5002 (12/26/18)
COLORADO DEPARTMENT OF REVENUE
Instructions for State of Colorado Affidavit of Exempt Sale
These instructions are specific to the State of Colorado in which this purchase has been made. Qualifying for an
exemption may be different for each local jurisdiction, and these instructions are not intended to set forth the requirements
of any local jurisdiction.
General Instructions
Purchaser Instructions
Purpose of Form
This form is used to certify to sellers that a purchase Purchase details. Identify the accurate qualified exemption
qualifies for exemption under Title 39, Article 26 of the reason and complete the required information for that
Colorado Revised Statutes. exemption.
For Sellers, accepting and keeping this document helps Purchaser information. Print the legal name of the
you get correct information about the purchaser, which organization or agency. Governmental agencies should
helps you prove this is an exempt sale during a tax audit. include both the name of the government and the
department or agency, for example, US Department of
For Purchasers, completing this document and giving it to
Transportation, Colorado Department of Education, or
a seller helps to speed up your purchase process.
Adams County Human Services. Abbreviations such as
_______________________________________________
“Dept.” are acceptable but do not use acronyms. List the
Reminders organization’s or agency’s mailing address, municipality,
Furnish to seller. This form should be furnished to the state, and zip code.
seller charging the tax. Do not send this form to the State
of Colorado. This form is not for organizations to request Declaration of affiant. The individual making the purchase
certification of their tax exempt status. on behalf of the exempt organization or agency (the affiant)
must complete the declaration.
Direct payment required. Purchases must be billed to and
paid directly by the funds of the organization or agency in
order to qualify for exemption. Payment in cash (without Separate form required. A separate affidavit is required
for each transaction. For ease of use, Purchase Details and
a purchase order) or by personal check or personal credit
Purchaser Information may be completed in advance and
card disqualifies a purchase from exemption even if the
the partially completed form kept on file by the purchaser
purchaser is subsequently reimbursed. Purchases made
for completion at time of each transaction.
on credit cards issued by the organization, but where the
cardholder receives and pays the bill and is subsequently
reimbursed, also do not qualify for exemption. Signature. You are swearing, under penalty of perjury,
to the accuracy of the statements made in this affidavit.
Reimbursement disqualifies exemption. If the
Carefully read and ensure that you understand each item
organization or agency will be reimbursed, in whole or
before signing this affidavit. After reviewing the form for
in part, the purchase is disqualified from exemption. For
accuracy, sign and date the form. Furnish this form to the
example, the purchase of food for a banquet for which the
seller. Do not send a copy to the State of Colorado.
organization sells tickets as a fundraiser would not qualify
for exemption.
Seller Instructions
Disputed tax must be collected. If there is a dispute
between the purchaser and the seller as to whether Sellers have the burden of proving that a transaction
tax applies, the seller that collects the tax must give was properly exempted. If an exemption is subsequently
the purchaser a receipt showing the tax collected. The disallowed by the State of Colorado, you (the seller) could
purchaser may apply to the applicable municipality directly be liable for the tax plus penalties and interest. This form
for a refund by filing a Claim for Refund form along with the is provided to help you determine if a sale qualifies for
appropriate documentation. exemption. The sale is not exempt from taxes simply
because this affidavit is completed. The responsibility
Signature required. The individual making the purchase for proper collection of taxes remains with the seller. You
must sign and date the form at the bottom. A separate are encouraged to obtain this form for each transaction
affidavit is required for each transaction. General purchaser and complete all of the information in the lower Seller
or store information may be completed in advance and kept Verification section.
on file by the seller or purchaser for ease of use.
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