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Certificate For Exempt Purchases: Form AS 2916.1

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Form AS 2916.

1 Commonwealth of Puerto Rico For seller's use


Rev. Sep 6 13 DEPARTMENT OF THE TREASURY
Invoice, receipt or
CERTIFICATE FOR EXEMPT PURCHASES transaction number:

(Tangible Personal Property and Exempt Services)


Transaction date: Month _______ Day _____ Year _____
The purpose of this Certificate for Exempt Purchases is to release the merchant seller from his or her obligation of collecting and remitting the sales and
use tax on the sale for which this Certificate for Exempt Purchases is issued.
PART I MERCHANT SELLER'S INFORMATION
Seller's name
Address

Municipality, State Zip Code


PART II PURCHASER'S INFORMATION
1.a. I certify that I am engaged in business in Puerto Rico and that my Merchant's Registration number is:
b. The North American Industry Classification System (NAICS) code that appears on my Merchant's Registration Certificate
is and the activity's description is the following: _____________________________________________________________.
2. If you are an agency of the Commonwealth of Puerto Rico or the Federal Government, provide your employer
identification number:
3. If you are a diplomat, provide the tax exemption number that appears on the exemption card issued by the United States Department of State:
and the expiration date: Month __________ Day ______ Year ______
4. If you are an individual affected by a disaster (Section 6080.12 of the Puerto Rico Internal Revenue Code of 2011, as amended (Code)), provide your driver's
license or passport number:
5. Indicate the reason for the exemption or exclusion and provide the requested information, as applicable:
a. Reseller (Municipal SUT) h. Farmer (Bona Fide Farmer's Number
b. Eligible Reseller _______________________________________________________)
c. Manufacturing Plant i. Direct Pay Permit (Total Exemption Certificate Number
d. Business to Business Services (except the services indicated _______________________________________________________)
in Section 4010.01(nn)(2)(A) of the Code) j. Housing Cooperative Ruled by Act 239-2004
e. Services Provided by Persons which Business Volume is k. Diplomat (Country or Mission _______________________________)
$50,000 or Less l. Special Acts (Act No. ______________________________________)
f. Federal Government (Agency ________________________) m. Exportation
g. Commonwealth of Puerto Rico n. Individual Affected by a Disaster (Section 6080.12 of the Code)
(Agency _________________________________________) o. Manufacture's Wholesale Distributor

6. I am engaged in the business of __________________________________ and I mainly sell ____________________________________.


7. I am purchasing:
a. Tangible personal property for resale (Municipal SUT)
b. Raw materials
c. Machinery and equipment used in manufacturing
d. Services provided to a business (except the services indicated in Section 4010.01(nn)(2)(A) of the Code
e. Tangible personal property according to special exemption granted under classifications 5.f. through 5.o. indicated above.
f. Repair services provided by persons with business volume of $50,000 or less (Section 4020.05(a)(1) of the Code)
g. Capitalized repair services of tangible personal property or real property
8. Describe the tangible personal property, services, raw materials, or machinery and equipment that you are purchasing:

PART III PURCHASER'S CERTIFICATION

I hereby declare under penalties of perjury that this certificate has been examined by me, and that to the best of my knowledge and belief all the
information provided herein is true, correct and complete. I also certify that:
. I am entitled to claim an exemption as indicated on line 5 of Part II, or I am duly authorized to represent the purchaser in the signature of this Certificate for Exempt
Purchases.
. I will only use this certificate to buy taxable items for which I am entitled to claim an exemption or exclusion.
. If I acquire taxable items, but I use or consume them for non-exempt purposes in Puerto Rico, I will report and pay the sales and use tax directly to the
Department of the Treasury.
. That the Provisional Reseller Certificate, Reseller Certificate or the Eligible Reseller Certificate is in force at the date of the purchase transaction.

Purchaser's name Purchaser's signature


Address Telephone

Municipality State Zip Code


Retention: Six (6) years.
INSTRUCTIONS

Who must complete this form?

This form must be completed by:

1. A purchaser registered in the Merchant’s Registry of the Department of the Treasury, that holds a valid Reseller Certificate, Eligible
Reseller Certificate or Exemption Certificate and purchases tangible personal property for resale (Municipal SUT), raw materials and
equipment used in manufacturing;

2. A purchaser registered in the Merchant’s Registry of the Department of the Treasury, that receives services from another merchant that
is also registered in said registry, except the services indicated in Section 4010.01(nn)(2)(A) of the Code;

3. A merchant that receives repair services by persons with business volume of $50,000 or less (Section 4020.05(a)(1) of the Code);

4. A merchant that receives capitalized repair services to tangible personal property or real property;

5. An agency of the Commonwealth of Puerto Rico or the Federal Government that acquires taxable items for its official use;

6. A bona fide farmer, duly certified by the Department of Agriculture, that acquires agricultural goods and machinery and equipment used
for said agricultural activity;

7. A merchant that holds a Total Exemption Certificate, which allows him or her to pay the sales and use tax directly to the Secretary of the
Treasury instead of paying it to the seller;

8. A housing cooperative ruled by Act 239-2004, that acquires materials and equipment to render the services compatible with its ends and
purposes;

9. A diplomat who holds a valid exemption card issued by the United States Department of State, that entitles him or her to claim an
exemption from the sales and use tax;

10. A person covered by any special act that provides an exemption from the payment of the sales and use tax;
11. A person who acquires taxable items for use or consumption outside of Puerto Rico; and

12. An individual affected by a disaster who acquires taxable items that constitute basic need articles required for the restoration, repair and
needs supply and damages caused by reason of the disaster.

The purchaser must provide this form to the seller at the moment of the purchase together with the Merchant’s Registration
Certificate, Reseller Certificate, Exemption Certificate or any other document evidencing the exemption requested on this
Certificate.

This Certificate should not be sent to the Department of the Treasury.

Instructions to the Purchaser

In order to be valid, all parts of this certificate must be completed. In addition, this certificate must be signed by the owner, partner, corporate
official or other person duly authorized to represent the purchaser.

If you intentionally issue a fraudulent Certificate for Exempt Purchases , you will be responsible for the payment of the sales and use tax, and
the applicable penalties.

Instructions to the Merchant Seller

If you are a seller registered in the Merchant’s Registry of the Department of the Treasury and accept a Certificate for Exempt Purchases, you
will be released from your obligation of collecting and remitting the sales and use tax. You are required to keep a copy of this certificate in your
files for a period of 6 years, counted from the filing date of the Sales and Use Tax Monthly Return, in which the exempt transaction is reported.

For your convenience, a space is provided in the upper right corner of this form so that the merchant seller can identify the invoice, receipt or
transaction number related to the transaction for which this Certificate for Exempt Purchases is issued.

Additional Information

Sales which are not supported by a valid Certificate for Exempt Purchases will be subject to the sales and use tax.

For additional information regarding this certificate, please contact the Department of the Treasury, visit any of the Merchant’s Service
Districts, or refer to the provisions of Internal Revenue Circular Letter No. 06-18 and Internal Revenue Circular Letter No. 13-04.

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