GENERAL  INSTRUCTIONS 
An Exemption Certificate may be used only to claim exemption from tax upon a purchase of 
tangible personal property or services which will be used for an exempt purpose as stated on this 
form. 
A purchaser may file a blanket Exemption Certificate with the vendor to cover additional 
purchases of the same general type of property or service. However, each subsequent sales slip 
or purchase invoice evidencing a transaction covered by a blanket Exemption Certificate must 
show the purchaser’s name, address and Business Registration Certificate Number for purposes 
of certification. 
 
                           INSTRUCTIONS FOR PURCHASER 
To purchase tangible personal property or services tax exempt, you must possess a valid 
Business Registration Certificate and you must properly complete this Exemption Certificate and 
present it to your supplier. To be properly completed, all entries on this Exemption Certificate 
must be filled in. 
Your Business Registration Certificate (and any duplicates) may be suspended or revoked if you 
or someone acting on your behalf willfully issues this certificate for the purpose of making a tax 
exempt purchase of tangible personal property and/or services that is not used in a tax exempt 
manner (as stated on this form). 
When property or services are purchased tax exempt with an Exemption Certificate, but later 
used or consumed in a non exempt manner, the purchaser must pay Sales or Use Tax on the 
purchase price. 
The willful issuance of a false or fraudulent Exemption Certificate with the intent to evade Sales or 
Use Tax is a misdemeanor.  
Your misuse of this Certificate with intent to evade the Sales or Use Tax shall also result in your 
being subject to a penalty of fifty percent of the tax that would have been due had there not been 
a misuse of such certificate. This is in addition to any other penalty imposed by the Law. In the 
event you make false or fraudulent use of this Certificate with intent to evade the tax, you may be 
assessed for the tax at any time subsequent to such use. 
 
                           INSTRUCTIONS FOR VENDOR 
At the time the property is sold or the service is rendered, you must obtain from your customer 
this Certificate, properly completed,(or a Direct Pay Permit number issued by the West Virginia 
Department of Tax and Revenue), or the sale will be deemed a taxable sale, unless the property 
or service sold is exempt per se from Sales Tax. Your failure to collect tax on such taxable sale 
will make you personally liable for the tax, plus penalties and interest. 
Additional information may be required to substantiate that the sale was for exempt purposes. In 
order for this Certificate to be properly completed, it must be issued by a purchaser who has a 
valid Business Registration Certificate and must have all entries completed by the purchaser. 
A timely received certificate which contains a material deficiency will be considered satisfactory if 
such deficiency is subsequently corrected. 
You must keep this certificate for at least three years after the due date of the last return to which 
it relates, or the date when such return was filed, if later. 
You must maintain a reasonable method of associating a particular exempt sale to a customer 
with the Exemption Certificate you have on file for such customer. 
 
                   INSTRUCTIONS FOR VENDOR AND PURCHASER 
If you, as vendor or as a purchaser, engage in any business activity in West Virginia without 
possessing a valid Business Registration Certificate (and you do not clearly qualify for an 
exemption), you shall be subject to a penalty in an amount not exceeding $100 for the first day on 
which such sales or purchases are made, plus an amount not exceeding $100 for each 
subsequent day on which such sales or purchases are made. 
Please begin using this Certificate immediately. 
  

Certificate of Exemption Instructions  
 
Use this form to claim exemption from sales tax on purchases of otherwise taxable items. 
The purchaser  must complete all fields on  the exemption  certificate and provide the fully 
completed certificate to the seller in order to claim exemption.  
  
Warning to purchaser: You are responsible for ensuring that you are eligible for the 
exemption  you are claiming.  You will be held liable for any tax and interest, and possibly 
penalties imposed by the member state due the tax on your purchase, if the purchase is not 
legally exempt.  
  
Purchaser instructions for completing the exemption certificate   
  
1.  Some purchasers may wish to complete a single certificate for multiple states 
where they conduct business and, regularly, make exempt purchases from the 
same seller.  If you do, check the box on the front of the Certificate of Exemption 
to indicate that you are attaching the Multistate Supplemental form.   
        
      If you are not attaching the Multistate Supplemental form, enter the two-
      letter postal abbreviation for the state under whose laws you are claiming 
      exemption. For example, if you are claiming an exemption from sales or 
      use tax imposed by the state of West Virginia, enter “WV” in the boxes 
      provided.  If you are claiming exemption for more than one state, complete 
      the Certificate of Exemption: Multistate Supplemental form.  
  
2.  Single purchase exemption certificate: Check this box if this exemption 
certificate is being used for a single purchase.  Include the invoice or purchase 
order number for the transaction.  
 
      If this box is not checked, this certificate will be treated as a blanket 
      certificate.   A blanket certificate  continues in force so long as the 
      purchaser is making recurring purchases     (at least one purchase within a 
      period of twelve consecutive months) or until otherwise cancelled by the 
      purchaser   .
      
3.  Purchaser information: Complete the purchaser and seller information 
section, as requested. An identification number for you or your business must be 
included. Include your state tax identification number and identify the state and/or 
country that issued the number to you. If you do not have a state tax identification 
number, enter the Federal Employers Identification Number (FEIN) issued to 
your business, or if no FEIN number is required, enter your personal driver’s 
license number and the state in which it is issued. Foreign diplomats and 
consular personnel must enter the individual tax identification number shown on 
the sales tax exemption card issued to you by the United States Department of 

State’s Office of Foreign Missions.  
 
    Multistate Purchasers:  The purchaser should enter its headquarters 
    address as its business address.    
  
4.  Type of business: Circle the number that best describes your business or 
organization. If none of the categories apply, circle number 20 and provide a brief 
description.  
 
5.  Reason for exemption:  Circle the exemption that applies to you or your 
business and enter the additional information requested for that exemption. If the 
member state that is due tax on your purchase does not require the additional 
information requested for the exemption reason code circled, enter “NA” for not 
applicable on the appropriate line.  If an exemption that is not listed applies, circle 
“ LOther” and enter an explanation. The explanation for “ LOther” must include a 
clear and concise explanation of the reason for the exemption claimed.  Some 
more common exemptions that may be listed as explanation could be: interstate 
carrier for hire, qualified air pollution equipment, enterprise zone, etc.  
 
    Multistate Purchasers: Attach the      Certificate of Exemption – Multistate 
    Supplemental Form and indicate the applicable reason for exemption and 
    identification number (if required) for each of the additional states in which 
    the purchaser wishes to claim exemption from tax.  
 
    CAUTION:  The exemptions listed are general exemptions most 
    commonly allowed by member states. However, each state’s laws 
    governing exemptions are different. Not all of the reasons listed may be 
    valid exemptions in the state in which you are claiming exemption. In 
    addition, each state has other exemptions that may not be listed on this 
    form. To determine what sales and use tax exemptions are allowed in a 
    particular state refer to the state’s web site or other information available 
    relating to that state’s exemptions.   
  
Seller: You are required to maintain proper records of exempt transactions and 
provide those records when requested.   These certificates may be provided in 
paper or electronic format.  If a paper exemption certificate is not forwarded by 
the purchaser, but instead the data elements required on the form are otherwise 
captured by the seller, the seller must maintain such data in the form in which it is 
maintained by the seller.  
  
You are relieved of the responsibility for collecting and remitting sales tax on the 
sale or sales for which the purchaser provided you with this exemption certificate, 

even if it is ultimately determined that the purchaser improperly claimed an 
exemption, provided all of the following conditions are met:  
  
  1. All fields on the exemption certificate are completed by the purchaser or the 
  required information   is captured and maintained. (The reason code ID # in 
  Section 5 is not required for the  exemption certificate to be fully 
  completed.);    
  2. The fully completed exemption certificate (or the required information) is 
  provided to you at the time of sale  
  3. If the purchaser is claiming an entity-based exemption (i.e., an exemption 
  based on who the purchaser is, such as a charitable organization), the state 
  that would otherwise be due the tax on the sale allows the specific entity-
  based exemption claimed by the purchaser if the purchase was made at a 
  sale location operated by the seller within that state;    
  4. If a business purchaser claims a multiple points of use exemption reason 
  code (note that effective dates for this exemption may vary by state) and 
  the items being purchased  are not tangible personal property other than 
  computer software;   
  5. You do not fraudulently fail to collect the tax due; or  
  6. You do not solicit customers to unlawfully claim an exemption.