RV-F1308401 (1/23)            
                                      TENNESSEE DEPARTMENT OF REVENUE
                                                      Application for Agricultural 
                                                      Sales and Use Tax Exemption

   1. Entity Name                                                                     FEIN/SSN/SOS#

   2. Mailing Address
                                      Street             City                                      State                         ZIP Code     
   3. Entity Phone No.                                                  Email Address

   4. Farm Location
                                      Street             City                                                              County     
   5. Entity Contact
                                      Name                                                         Email Address
   6. Type of Entity           Farmer Timber Harvester        Nursery Operator

   7. Type of Ownership
        a.     Partnership            d.       Sole Proprietorship                       g.        Marital Joint Ownership (must provide SSN for joint owners)  
      b.     Professional LLC    e.       Limited Partnership                      h.        Limited Liability Company      
       c.      S Corporation        f.      Other Professional Corporation   i.        Corporation 

   8. Applicant must meet at least one of the following criteria to qualify for the agricultural exemption.  Check all that   
   apply.  You must submit proper documentation with the application (see instructions).
        a. The owner or lessee of agricultural land from which $1,500 or more of agricultural products were  
           produced and sold during the year, including payments from government sources. 
        b. In the business of providing for-hire custom agricultural services for the plowing, planting, harvesting,                                             
             growing, raising, or processing of agricultural products or for the maintenance of agricultural land. 
        c. The owner of land that qualifies for taxation under the provisions of the Agricultural Forest and Open                                                
             Space Land Act of 1976 (Tenn. Code Ann. § 67-5-1001 et seq.). 
        d. Have a federal income tax return that contains one or more of the following: 
           i.        Business activity on IRS Schedule F (Profit or Loss from Farming) 
           ii.       Farm rental activity on IRS Form 4835 (Farm Rental Income and Expenses) or Schedule E 
                     (Supplemental Income and Loss)
        e.   Otherwise establish to the satisfaction of the Commissioner of Revenue that you are actively engaged in    
             the business of raising, harvesting, or otherwise producing agricultural commodities as defined in Tenn. 
           Code Ann. § 67-6-301 (c)(2). 
   
                                                      Affidavit of Applicant
Under penalties of perjury, I declare to the best of my knowledge this information is true and correct.  I understand any             
authority given from this application is limited to purchases of tangible personal property used primarily in agricultural             
operations as authorized in Tenn Code Ann. § 67-6-207. The use of this authority for purposes other than those authorized by 
law may result in the assessment of additional taxes, penalties, and interest.

Print Name                                              Title                                                                                                    

Signature                                                Date 

                                      Please mail application and attachments to: 
                                                      Tennessee Department of Revenue 
                                                      Taxpayer Services Division 
                                                      500 Deaderick Street 
                                                      Nashville, TN  37242

 Tenn. Code Ann. § 67-6-207 provides a sales and use tax exemption to “qualified farmers and nursery operators” for the 
 purchase of tangible personal property used primarily (more than 50%) in agricultural operations. Please see the De-
 partment’s tax manual for additional information about the types of property that qualify for the exemption. A qualified 
 farmer or nursery operator is someone who: 
  
   1)  is the owner or lessee of agricultural land from which $1,500 or more of agricultural products were produced            
        and sold during the year, including payments from government sources,
   2)  is in the business of providing for-hire custom agricultural services for the plowing, planting, harvesting,  
        growing, raising, or processing of agricultural products or for the maintenance of agricultural land,
   3)  is the owner of land that qualifies for taxation under the provisions of the Agricultural Forest and Open Space         
        Land Act of 1976,
   4)  has a federal income tax return that contains business activity on IRS Schedule F, farm rental activity on IRS          
        Form 4835, and/or farm rental activity on IRS Schedule E, or
   5)  can otherwise establish to the satisfaction of the Commissioner that he/she is actively engaged in the business 
        of  raising, harvesting, or otherwise producing agricultural commodities as defined in Tenn. Code Ann. § 67-6-         
        301(c)(2). 
  
 A qualified farmer, timber harvester, or nursery operator must apply for and receive an Agricultural Sales and Use Tax 
 Certificate of Exemption before making tax-exempt purchases. Applicants must complete this form in its entirety and 
 mail it and all requested information to the Department of Revenue at the address on the front page.  If the application is 
 approved, the Department will issue the applicant an Agricultural Sales and Use Tax Certificate of Exemption.  The Depart-
 ment reissues the Agricultural Sales and Use Tax Certificate of Exemption every four years. 
  
 When purchasing tangible personal property used primarily in agriculture operations tax-exempt, purchasers must 
 present to the seller a copy of their Agricultural Sales and Use Tax Certificate of Exemption, a copy of the exemption card 
 included with certificate, or a fully completed Streamlined Sales Tax Certificate of Exemption that includes the agriculture 
 exemption number issued by the Department.

  Instructions:
   
  1) - 5)  Business information. 
 
   6) Indicate the type of entity. 
 
   7) Indicate the type of legal ownership of the entity. 
 
   8) You must meet at least one of the listed criteria in order to qualify for the exemption. Indicate which 
      criteria are met.  You must submit with this application the following supporting documentation  
      depending on the criteria that is selected. 
 
      a)           Proof of government payments and/or copies of tax returns reflecting income information.  
 
      b)           Copies of Form 1099. 
 
      c)           A copy of the qualification of the land under the Agricultural Forest and Open Space Land Act. 
 
      d)(i)        A copy of Schedule F. 
 
      d)(ii)       A copy of Form 4835 or Schedule E, whichever is applicable. 
 
      e)           A detailed statement of why you qualify for the agricultural exemption. If you have recently begun 
                   agricultural operations or have just acquired your land, you should also submit a business plan that
                   includes the following information:

                    •    Date the land was acquired.

                    •    Number of acres under cultivation and/or breed and number of livestock being raised.

                    •    Projected date of first sale of agricultural product and projected income.

                    •    Marketing plan (how will you sell your agricultural product?).