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Explains purchaser responsibility for eligibility, potential liability for tax, interest, and civil or criminal penalties, and conditions when sellers must provide exemption certificate data to the state. Includes instructions to attach a Multistate Supplemental form, enter the two-letter state abbreviation if applicable, provide purchaser and seller details, tax ID information, seller address category selection, and declaration/signature fields, plus a North Carolina Department of Revenue assignment letter.","This is a multi-state form.Not all states allow allexemptions listed on this form.Purchasers are responsible for knowing if theyqualify to claim exemption from tax in the state that would otherwise be due tax on this sale.The seller may be required to providethis exemption certificate (or data elements required on the form)to a state that would otherwise be due tax on this sale.  \nThe purchaser will be held liable for any tax and interest,and possibly civiland criminal penalties imposed by the memberstate,if the purchaser is not eligible to claim this exemption.A seller may not accept a certificate of exemption for anentity-based exemption on a sale made at a location operated by the seller within the designated state if the state doesnot allow such an entity-based exemption.  \nCheck if you are attaching the Multistate Supplemental form.NC▼ If not,enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption.  \n\n| Please print   |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Name o purchaser   |  |  |  |  |\n| WINSTON-SALEM STATE UNIVERSITY   |  |  |  |  |\n| Business address   |  |  | City   | Zip code  \u003Cbr>State   |\n| 601 S.MARTIN LUTHER KING    | JR.DR.  \u003Cbr>WINSTON-SALEM   |  |  | 27110  \u003Cbr>NC   |\n| Purchaser's tax ID number   |  |  | State of issue   | Country of issue   |\n| 400016   |  |  | NC   | USA   |\n| f no tax ID number,  \u003Cbr>FEIN  \u003Cbr>enter one of the following:  \u003Cbr>56-6001466   | Driver's license nu  \u003Cbr>state of issue   |  | mber/State issued ID number  \u003Cbr>number   | Foreign diplomat number   |\n| Name of seller from whom you are purchasing,leasing,or r   | enting   |  |  |  |\n\n□ A Federal government(department)       ☑B State   government (name)AGENCY    \n6 Sign here.I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.  \n\n| Sianatuire of aiuthorized nurchaser  \u003Cbr>Signature of aythorized purchaser  \u003Cbr>Phone number  \u003Cbr>100   | Print name here  \u003Cbr>FRANK LORD  \u003Cbr>E-mail address   | CONTROLLER 01-13-20   |\n| --- | --- | --- |\n| (336)750-2733   | lordfe@wssu.edu   |  |\n\nE-595E  \n1  \n2  \n3  \nSeller's address  \n01 Accommodation and food services02 Agricultural,forestry,fishing,and hunting03 Construction04 Finance and insurance  \n05 Information,publishing,and communications06 Manufacturing07 Mining08 Real estate09 Rental and leasing10 Retail trade  \n5  \n# Streamlined Sales and Use Tax AgreementCertificate of Exemption\n\n  Check if this certificate is for a single purchase and enter the related invoice/purchase order\\#         +  \nCity  \nI Industrial production/manufacturing\\#_                \nZip code  \nState  \n11 Transportation and warehousing  \n12 Utilities  \n13 Wholesale trade  \n14 Business services  \n15 Professional services  \n16 Education and health-care services  \n17 Nonprofit organization  \n18 Government  \n19 Not a business  \n20 Other(explain)                                    \n\n| Name of purchaser   |  |  |  |\n| --- | --- | --- | --- |\n| WINSTON-SALEM   |  STATE UNIVERSITY   |  |  |\n| State   | Reason for exemption   |  | Identification number(if required)   |\n| AR   |  |  |  |\n| GA   |  |  |  |\n| IA   |  |  |  |\n| IN   |  |  |  |\n| KS   |  |  |  |\n| KY   |  |  |  |\n| MI   |  |  |  |\n| MN   |  |  |  |\n| NC   | G.S.105-164.13(52)   |  | 400016   |\n| ND   |  |  |  |\n| NE   |  |  |  |\n| NJ   |  |  |  |\n| NV   |  |  |  |\n| OH   |  |  |  |\n| OK   |  |  |  |\n| RI   |  |  |  |\n| SD   |  |  |  |\n| TN*   |  |  |  |\n| UT   |  |  |  |\n| VT   |  |  |  |\n| WA   |  |  |  |\n| WI   |  |  |  |\n| WV   |  |  |  |\n| WY   |  |  |  |\n\n*SSUTA Direct Mail provisions are not in effect for Tennessee.  \nNorth Carolina Department of Revenue  \nE.Norris Tolson  \nMay 12,2004  \nSecretary  \nWINSTON-SALEM STATE UNIVERSITYATTN FRANK LORDIⅢ CONTROLLERCAMPUS BOX 19463WINSTON-SALEM NC 27110  \nDear Mr.Lord IIl:  \nPursuant to your recent application,we are assigning your agency exemption number400016 as its authority for purchasing items subject to","cbCaibBkOfO9iXXB","https://ap.wps.com/l/cbCaibBkOfO9iXXB","pdf",258441,3,"English","en",105,"# Declaration and Instructions\n## Multistate Supplemental Form and State Abbreviation\n## Purchaser and Seller Information\n# Exemption Authority, Eligibility, and Liability\n## Purchaser Responsibility and Penalties\n## Seller Requirements for Exemption Certificates\n# Signature and Certification Fields\n## Authorized Purchaser Signature and Contact Info\n# Seller Category and State-Specific Notes","[{\"question\":\"What is the purchaser’s main responsibility when claiming a tax exemption?\",\"answer\":\"The purchaser must know whether they qualify to claim the exemption in the state where tax would otherwise be due on the sale.\"},{\"question\":\"What happens if the purchaser is not eligible to claim the exemption?\",\"answer\":\"The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state.\"},{\"question\":\"When might the seller be required to provide exemption certificate information to a state?\",\"answer\":\"The seller may be required to provide the exemption certificate (or required data elements) to the state that would otherwise be due tax on the sale.\"}]","Streamlined Sales and Use Tax Agreement - Certificate of Exemption | 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