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                                                                                                                    ST: EX-A1
                                   ALABAMA DEPARTMENT OF                                  REVENUE                           5/20
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                                          SALES AND      USE AXT                         DIVISION

         Application for Sales Tax Certificate of Exemption

    An Alabama Sales Tax Certificate of Exemption shall be used by persons, firms, or corporations coming under the provi-
sions of the Alabama Sales Tax Act who are not required to have a Sales Tax License.
    PLEASE COMPLETE EACH LINE APPLICABLE TO YOUR BUSINESS.  A SALES TAX CERTIFICATE OF EXEMP-
TION WILL NOT BE ISSUED UNTIL THIS APPLICATION IS PROPERLYCOMPLETED.
1. Federal Employer Identification Number (FEIN) _______________________ 2. Business Telephone (______)_____________
3. ___________________________________________________________________________________________________________
    NAME OF PERSON(S), FIRM, CORPORATION, ASSOCIATION, CO-PARTNERSHIP MAKING APPLICATION.
    __________________________________________________________________ 4. Contact Person _________________________________
    GIVE TRADE NAME
5. Mailing address of home office________________________________________________________________________________
                                                    P. O. BOX OR STREET NO. OR R.F.D.
    ___________________________________________________________________________________________________________
    CITY                                   COUNTY                                           STATE                   ZIP CODE
6. Number of businesses in Alabama __________ Location __________________________________________________________
                                                    CITY                                    STREET AND NO. OF HWY.  COUNTY
    Location must be exact street number or, if on highway or rural route, give details of location.  If more than one location,
    please attach schedule._______________________________________________________________________________________
7. Would you like to receive a courtesy email notification to renew your certificate?  6 No   6 Yes
    If Yes, enter email address ___________________________________________________________________________________
8. Kind and Class of Business ___________________________________________________________________________________
                          (NON-PROFIT, WHOLESALER, MANUFACTURER, ETC.)
9. Type Product Manufactured and/or sold_______________________________________________________________________
10. REASON EXEMPTION CLAIMED         ___________________________________________________________________________
11. Form of ownership:  6 Individual 6 Partnership  6 Corporation                         6 Multi member LLC 6 Single member LLC
    If applicant is a corporation, a copy of the certified certificate of incorporation, amended certificate of incorporation,
      certificate of authority, or articles of incorporation should be attached.  If the applicant is a limited liability company or a
    limited liability partnership, a copy of the certified articles of organization should be attached.
12. Ownership information (please attach):
    Corporations – give name, title, home address, and Social Security Number of each officer.
    Partnerships – give name, home address, Social Security Number or FEIN of each partner, and valid Alabama driver’s
         license or other acceptable citizenship  documentation.
    Sole Proprietorships – give name, home address, Social Security Number of owner, and valid Alabama driver’s license or
         other acceptable citizenship documentation.
    LLC – give name, home address, and Social Security Number or FEIN of each member. (Valid Alabama driver’s license
         or other acceptable citizenship documentation is required for single member LLCs.)
    LLP – give name, home address, and Social Security Number or FEIN of each partner.

Signed _______________________________________________          Signed _______________________________________________

Title __________________________ Date __________________        Title __________________________ Date __________________

                          MAIL ORIGINAL APPLICATION TO THE TAXPAYER SERVICE CENTER
                   v LISTED ON PAGE TWO THAT SERVES THE COUNTY IN WHICH YOU ARE LOCATED.                           c
                                          REVENUE DEPARTMENT USE ONLY
Examiner’s Remarks ____________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
                                           Examiner _____________________________________ Date ___________________
Supervisor’s Recommendation ___________________________________________________________________________________
_______________________________________________________________________________________________________________
                                           Supervisor _____________________________________ Date ___________________



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                              Taxpayer Service Centers

• AUBURN/OPELIKA                           • MOBILE 
3300 Skyway Drive, Auburn (Zip 36830)      Bel Air Tower Suite 100
3320 Skyway Drive, Suite 808               851 E. I-65 Service Road South (Zip 36606)
Opelika, AL 36801                          P.O. Drawer 160406
Telephone: (334) 887-9549                  Mobile, AL 36616-1406
                                           Telephone: (251) 344-4737
Counties:
Chambers      Lee             Talladega    Counties:
Clay          Randolph        Tallapoosa   Baldwin        Conecuh       Monroe
Coosa         Russell                      Choctaw        Escambia      Washington
                                           Clarke         Mobile        Wilcox
• DOTHAN 
121 Adris Place (Zip 36303)                • MONTGOMERY 
P.O. Box 5739                              2545 Taylor Road (Zip 36117)
Dothan, AL 36302-5739                      P.O. Box 327490
Telephone: (334) 793-5803                  Montgomery, AL 36132-7490
                                           Telephone (334) 242-2677
Counties:
Barbour       Dale            Henry        Counties:
Coffee        Geneva          Houston      Autauga        Crenshaw      Macon
Covington                                  Bullock        Dallas        Montgomery
                                           Butler         Elmore        Pike
• GADSDEN                                  Chilton        Lowndes
701 Forrest Avenue (Zip 35901)
P.O. Box 1190                              • TUSCALOOSA 
Gadsden, AL 35902-1190                     1434 22nd Avenue (Zip 35401)
Telephone: (256) 547-0554                  P.O. Box 2467
                                           Tuscaloosa, AL 35403-2467
Counties:
                                           Telephone: (205) 759-2571
Blount        Cleburne        Marshall
Calhoun       DeKalb          St. Clair    Counties:
Cherokee      Etowah                       Bibb           Marengo       Sumter
                                           Fayette        Marion        Tuscaloosa
                                           Greene         Perry         Walker
• HUNTSVILLE                               Hale           Pickens       Winston
4920 Corporate Drive, Suite H (Zip 35805)  Lamar
P.O. Box 11487
Huntsville, AL 35814-1487
Telephone: (256) 837-2319                  • OUT-OF-STATE:
                                           Foreign Audit
Counties:
                                           Alabama Department of Revenue
Colbert       Jackson         Limestone
                                           Sales and Use Tax Division
Cullman       Lauderdale      Madison
                                           P.O. Box 327740
Franklin      Lawrence        Morgan
                                           Montgomery, AL 36132-7740
• JEFFERSON/SHELBY
2020 Valleydale Road, Suite 208 (Zip 35244)
P.O. Box 1927
Pelham, AL 35124
Telephone: (205) 733-2740
Counties:
Jefferson     Shelby






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