Arizona Form 
                                                       Transaction Privilege Tax Exemption Certificate
                              5000
         Do not use Form 5000 to claim sale for resale.  Use Form 5000A.
         Do not use Form 5000 if you are a non-TPT licensed contractor.  Use Form 5000M.
This Certificate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009.  The purpose of the 
Certificate is to document and establish a basis for state and city tax deductions or exemptions.  It is to be filled 
out completely by the purchaser and furnished to the vendor at the time of the sale.  The vendor shall retain 
this Certificate for single transactions or for the specified period as indicated below.  Incomplete Certificates are 
not considered to be accepted in good faith.  Only one category of exemption may be claimed on a Certificate.

A.  Purchaser’s Name and Address:                                      B.  Check Applicable Box:
Name
                                                                        Single Transaction Certificate
 Address
                                                                        Period From                        Through  
City                                   State           ZIP Code        (You must choose specific dates for which the certificate will be valid. You 
                                                                       are encouraged not to exceed a 12 month period. However, a certificate will be 
                                                                       considered to be accepted in good faith for a period not to exceed 48 months if the 
Vendor’s Name                                                          vendor has documentation the TPT license is valid for each calendar year covered 
                                                                       in the certificate.)

C.  Choose one transaction type per Certificate:
 Transactions with a Business                                          Transactions with Native Americans, Native American 
                                                                         Businesses and Tribal Governments (See reason #12.)
Arizona Transaction Privilege Tax (TPT) License Number                 Tribal Business License Number  OR    Tribal Number

SSN / EIN                                                              Name of Tribe                        Tribal Government 
                                                                                                            
Other Tax License Number                                                Transactions with a U.S. Government entity 
                                                                             (See reasons #9 and #10.)
If no license, provide reason:
                                                                        Transaction with a Foreign Diplomat  (See reason #13.)
Precise Nature of Purchaser’s Business.

D.  Reason for Exemption:  
Check the box indicating one of the more common exemptions provided below, or use Box 14 or 15 to cite the appropriate 
authority for another exemption (deduction).  Refer to www.azdor.gov/Forms/TransactionPrivilegeTax.aspx for a 
complete list of state and city exemptions (deductions) and the business classes (codes) under which the deductions apply. 
 1. Tangible personal property to be leased or rented in the ordinary course of the purchaser’s licensed business.
 2. Tangible personal property to be incorporated into a taxable contracting project, or a maintenance, repair, replacement or alteration 
     project. 
 3. Food, drink, or condiments purchased by a restaurant business.
 4. Pipes or valves four inches in diameter or greater to be used for transportation of oil, natural gas, artificial gas, water or coal slurry.
 5. Railroad rolling stock, rails, ties, and signal control equipment.
 6. Machinery or equipment used directly in the following business activities:
      Manufacturing, processing or fabricating.        Job printing.          Refining or metallurgical operations. 
      Extraction of ores or minerals from the earth for commercial purposes. 
      Extraction of, or drilling for, oil or gas from the earth for commercial purposes.
 7. Other income producing capital assets.  (Cities only.) 
 8. Food, drink or condiments for consumption within the premises of any prison, jail or other institution under the jurisdiction of the 
     state department of corrections, the department of public safety, the department of juvenile corrections or a county sheriff.  Food, 
     drink, condiments or accessories purchased by a school district for consumption at a public school within the district during school 
     hours.
 9. Tangible personal property sold or leased directly to the United States Government or its departments or agencies by a manufacturer, 
     modifier, assembler or repairer.   (Retail, personal property rental and mining classifications only.)
  10. Fifty percent of the gross proceeds or gross income from the sale of tangible personal property directly to the United States 
     Government or its departments or agencies.  (Retail classification only.) 
ADOR 10308 (3/19)                                                                                           Continued on page 2 

Your Name (as shown on page 1)                                                            Arizona Transaction Privilege Tax License Number

 11. Electricity, natural gas or liquefied petroleum  gas sold to a qualified manufacturing or smelting business.  A manufacturing or 
     smelting business that claims this exemption authorizes the release by the vendor of the information required to be provided to 
     the Department of Revenue pursuant to A.R.S. §42-5063(C)(6). (Utilities classification only.)
 12. Sale or lease of tangible personal property to affiliated Native Americans if the solicitation for sale, signing of the contract, 
     delivery of the goods and payment for the goods all occur on the reservation.  NOTE:          The vendor shall retain adequate 
     documentation to substantiate the transaction.
 13. Foreign diplomat.  NOTE:            Limited to authorization on the U.S. Department of State Diplomatic Tax 
     Exemption Card.  The vendor shall retain a copy of the U.S. Department of State Diplomatic Tax Exemption 
     Card and any other documentation issued by the U.S. Department of State.  Motor vehicle purchases or 
     leases must be pre-authorized by the Office of Foreign Missions (“OFM”).  See “Vehicle Tax Exemption”  
     at www.state.gov/ofm/tax/
 14.*Other Deduction:  Cite the Arizona Revised Statutes authority for the deduction.  A.R.S. §      
     Description: 

 15.*Other Cities Deduction:  Cite the Model City Tax Code authority for the deduction.  M.C.T.C §   
     Description: 

*Refer to www.azdor.gov/TransactionPrivilegeTax(TPT)/RatesandDeductionCodes.aspx for a complete list of state and city 
     exemptions (deductions) and the business classes (codes) under which the deductions apply.

E.  Describe the tangible personal property or service purchased or leased and its use below.   
 (Use additional pages if needed.)

F.  Certification
A vendor that has reason to believe that this Certificate is not accurate or complete will not be relieved of the burden of 
proving entitlement to the exemption.  A vendor that accepts a Certificate in good faith will be relieved of the burden of proof 
and the purchaser may be required to establish the accuracy of the claimed exemption.  If the purchaser cannot establish 
the accuracy and completeness of the information provided in the Certificate, the purchaser is liable for an amount equal to 
the transaction privilege tax, penalty and interest which the vendor would have been required to pay if the vendor had not 
accepted the Certificate.  Misuse of this Certificate will subject the purchaser to payment of the A.R.S. § 42-5009 amount equal 
to any tax, penalty or interest.  Willful misuse of this Certificate will subject the purchaser to criminal penalties of a felony 
pursuant to A.R.S. § 42-1127(B).

I, (print full name)                                                          , hereby certify that these transactions are 
exempt from Arizona transaction privilege tax and that the information on this Certificate is true, accurate and complete.  
Further, if purchasing or leasing as an agent or officer, I certify that I am authorized to execute this Certificate on behalf of 
the purchaser named above.

SIGNATURE OF PURCHASER                                      DATE              TITLE
ADOR 10308 (3/19)                                                                                    Page 2 of 2
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