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Instructions for Standard Municipal Home Rule Affidavit of Exempt Sale
These instructions are specific to the jurisdiction in which this purchase has been made.
Qualifying for an exemption may be different for each jurisdiction, and these instructions are not
intended to set forth the requirements of any jurisdiction other than the one indicated.
General Instructions Seller Instructions
Purpose of Form Sellers have the burden of proving that a transaction was properly
exempted. If an exemption is subsequently disallowed by the
This form is used to certify to sellers that a purchase qualifies for municipality, you (the seller) could be liable for the tax plus penalties
exemption under Chapter 1 of Title 3 of the Breckenridge Town Code. and interest. This form is provided to help you determine if a sale
For Sellers, accepting and keeping this document helps you obtain qualifies for exemption. The sale is not exempt from taxes simply
correct information about the purchaser, which helps you prove this is because this affidavit is completed. The responsibility for proper
an exempt sale during a tax audit. collection of taxes remains with the seller. You are encouraged to
obtain this form for each transaction and complete all of the information
For Purchasers, completing this document and giving it to seller helps in the lower Seller Verification section.
to speed up your purchase process.
Resale/Wholesale transaction s. To qualify as an exempt purchase for
Reminders resale or wholesale, the items purchased must be reasonably deemed
to be for sale in the ordinary course of business of the purchaser. For
Furnish to seller. This form should be furnished to the seller charging resale/wholesale transactions the seller is required to not only collect
the tax. Do not send this form to the taxing jurisdiction. This form is not the applicable license information, but to exercise sound judgment and
for organizations to request certification of their tax-exempt status. a reasonable amount of skepticism to ensure the items purchased are
Direct payment required. Purchases must be billed to and paid reasonably for sale in the purchaser’s ordinary course of business. For
directly by the funds of the organization or agency in order to qualify for example, a restaurant would not be allowed to purchase dish soap for
exemption. Payment in cash (without a purchase order) or by personal resale because restaurants do not sell dish soap in the ordinary course
check or personal credit card disqualifies a purchase from exemption of business, but rather use the dish soap in the operation of the
even if the purchaser is subsequently reimbursed. Purchases made on business.
credit cards issued by the organization, but where the cardholder The affidavit needs to be completed in its entirety. Be sure
receives and pays the bill and is subsequently reimbursed, also do not information is complete, accurate and legible. Review the information,
qualify for exemption. and particularly verify that the driver’s license number and purchaser’s
Reimbursement disqualifies exemption. If the organization or name are correct. Also, be sure that the digits that are required from
agency will be reimbursed, in whole or in part, the purchase is the credit cards are correct. Only record and keep those digits from the
disqualified from exemption. For example, the purchase of food for a credit card that the affidavit requires. The signature of the purchaser
banquet for which the organization sells tickets as a fundraiser would should be the same as on the driver license.
not qualify for exemption. Sellers should review guidance on accepting government credit
Disputed tax must be collected. If there is a dispute between the cards. Not all cards qualify for exemption, even though they bear
purchaser and the seller as to whether tax applies, Chapter 1 of Title 3 certain of the listed characteristics.
of the Breckenridge Town Code requires the seller to collect the tax. Collection of this form does not provide a safe-harbor from
The seller must give the purchaser a receipt showing the tax collected. disallowance by the municipality. Retain this form for at least 3
The purchaser may apply to the applicable municipality directly for a years.
refund by filing a Claim for Refund form.
Signature required. The individual making the purchase must sign and
date the form at the bottom. A separate affidavit may be required for Jurisdiction Specific Instructions
each transaction. General purchaser or store information may be Wholesale Sales. Sales to licensed retailers, jobbers, dealers or
completed in advance and kept on file by the seller or purchaser for wholesalers for resale. Sales by wholesalers to consumers are not
ease of use. wholesale sales. Sales by wholesalers to nonlicensed retailers are not
wholesale sales.(see also exemption 3-1-4(M))
Purchaser Instructions State License Number. State Tax Exempt Number. State and Local
Government. Paid by government purchase card as designated on the
Purchase details. Identify the accurate qualified exemption reason and card. Out of state licenses are accepted. However, it is required that you
complete the required information for that exemption. note the State abbreviations next to the required #, if other than Colorado.
Ex. STATE LICENSE NUMBER (NOT FEIN NUMBER) KS 05-14322-0000
Purchaser information. Print the legal name of the organization or STATE TAX EXEMPT NUMBER TX 09803970
agency. Governmental agencies should include both the name of the STATE TAX EXEMPT NUMBER PRINTED ON THE CARD TX 09803970 (not printed on card)
government and the department or agency, for example, US Other Qualified Exemption. Other exemption reasons included in the
Department of Transportation, Colorado Department of Education, or Chapter 1 of Title 3 of the Breckenridge Town Code, but not separately
Adams County Human Services. Abbreviations such as “Dept.” are listed on this form:
acceptable but do not use acronyms. List the organization’s or agency’s
mailing address, municipality, state, and zip code. Schools. All sales made to schools, other than schools held or
conducted for private or corporate profit.
Expedite purchase. Purchase details and purchaser information may
be completed in advance and the partially completed form kept on file Exempt Construction Materials. All sales of construction materials to
by the purchaser for completion at time of each transaction. contractors and subcontractors for use in the building, erection,
Declaration of affiant. The individual making the purchase on behalf of alteration, or repair of structures, highways, roads, streets, and other
the exempt organization or agency (the affiant) must complete the public works owned and used by: The United States government, the
declaration. state, its departments and institutions, the political subdivisions thereof
in their governmental capacities only; Charitable organizations, as
Signature. You are swearing, under penalty of perjury, to the accuracy defined in section 3-1-2 of this chapter, in the conduct of their regular
of the statements made in this affidavit. Carefully read and ensure that charitable functions and activities; or Schools, other than schools held
you understand each item before signing this affidavit. After reviewing or conducted for private or corporate profit.
the form for accuracy, sign and date the form. Furnish this form to the FOR THE FULL TEXT OF APPLICABLE DEFINTIONS AND EXEMPTIONS,
seller. Do not send a copy to the municipality. PLEASE SEE BRECKENRIDGE TOWN CODE 3-1-4.
Page 2 of 2 Revised 4/1/2015
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