Commercial Texas Sales and Use Tax Exemption Certificate
*Name of Purchaser, Firm or Agency:
*Account Number:
*Address:
*City:
*State:
*ZIP Code:
*Phone Number:
*Email Address:
I, the purchaser named above, claim an exemption from payment of sales and use taxes for the purchase of taxable items described below or on the attached order or invoice:
Seller Information:
MEDINA ELECTRIC COOPERATIVE, INC.
PO BOX 370
HONDO, TX 78861-0370
 
Description of items to be purchased: Electricity
PLEASE COMPLETE ONLY ONE SECTION A, B, OR C (AS APPLICABLE)

Select Section B for Apartment Complexes or Cotton Gins.

Select Section A for 100% Nontaxable Usage. (Utility Study not Required)

Select Section C if electricity used is less than 100%, but more than 50% (Utility Study REQUIRED).
Select applicable Section:
Section A. Utility Study not required for 100% Nontaxable Usage
Check only ONE: Purchaser claims this exemption for the following tax exempt reason:
Electricity is used 100% in exploring for, producing or transporting a material extracted from the earth.
Texas Direct Permit Number
Permit Number (11-digit):
Purchase by Exempt Organization that has obtained a Texas Comptroller letter of exempt status under IRC Code Section. Specify Type of Code Section.
Type or Code Section:
Other (specify Texas Tax Code Section and use of electricity):
Other use and Tax Code Section:
Section B. Utility Study not required - Only for Use by Apartment Complexes or Cotton Gins
Customer declares electricity is used less than 100%, but more than 50% for residential purpose in an apartment complex.
Customer declares electricity is used less than 100%, but more than 50% for processing in a Cotton Gin.
Section C. Predominant Use Exemption
Customer declares electricity is used less than 100%, but more than 50%, for a tax exempt purpose and affirms that a valid and complete study has been performed which shows that the percentage of electricity listed below is used for the following tax exempt purpose: (check only one)
Percentage used:
Manufacturing, processing or fabricating tangible personal property for sale in the regular course of business.
Other tax exempt use (specify exact use):
Other use:

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Owner's (Customer's) Signature
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Date Signed: (MM/DD/YYYY)
I understand that I will be liable for payment of all state and local sales or use taxes which may become due for failure to comply with the provisions of the Tax Code and/or all applicable law.

I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know, at the time of purchase, will be used in a manner other than that expressed in this certificate and, depending on the amount of tax evaded, the offense may range from a Class C misdemeanor to a felony of the second degree.

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Authorized signature
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Name:
Official Title:
Date Signed: (MM/DD/YYYY)



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