Missouri Sales Tax Project Exemption Certificate

Sales Tax Project Exemption Certificate
Form 5060 Project Exemption Certificate
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Form

5060

Project Exemption Certificate

This form is to be completed and given to your contractor.
Name of Exempt Entity Issuing the Certificate			

	Missouri Tax Exemption Number
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Address			

City					

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State	

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ZIP Code

Exempt Entity and Project Information

E-mail Address
Project Number		

Project Begin Date (MM/DD/YYYY)	

Estimated Project End Date (MM/DD/YYYY)

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Description of Project

Project Location	

Certificate Expiration Date (MM/DD/YYYY)
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Provide a signed copy of this certificate, along with a copy of the exempt entity’s Missouri Sales and Use Tax Exemption
Letter to each contractor or subcontractor who will be purchasing tangible personal property for use in this project. It is the
responsibility of the exempt entity to ensure the validity of the information on the certificate. The exempt entity must issue a new
certificate if any of the information changes.
Signature of Authorized Exempt Entity	

Printed Name of Authorized Exempt Entity	

Date (MM/DD/YYYY)

Subcontractor

Contractor

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The Missouri exempt entity named above hereby authorizes the purchase, without sales tax, of tangible personal property to be
incorporated or consumed in the construction project identified herein and no other, pursuant to Section 144.062, RSMo. Under
penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Name of Purchasing Contractor	
Signature of Contractor 	
Date (MM/DD/YYYY)
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Address			

City		

State	

ZIP Code

Contractors - Present this to your supplier in order to purchase the necessary materials tax exempt. Complete the Subcontractor
portion if extending the certificate to your subcontractor. The contractor must sign the form in the space provided below.
Name of Purchasing Subcontractor
Address			
Signature of Contractor	

City		

Contractor’s Printed Name	

State	

ZIP Code

Date (MM/DD/YYYY)
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Form 5060 (Revised 11-2019)

Taxation Division	
P.O Box 358	
Jefferson City, MO 65105-0358	

Phone: (573) 751-2836
Fax: (573) 522-1666
E-mail: [email protected]

Visit http://dor.mo.gov/business/sales/sales-use-exemptions.php for additional information.