Application For Sales Tax Exemption

The Pennsylvania Department of Revenue requires utilities to have a Pennsylvania Sales Tax Exemption Certificate on file for each meter on their system. For your account to be tax exempt, one of the following reasons must apply. Select the appropriate option.

Name:
Account Number:
Location:
Email Address:

Property Options This is my primary residence.
Vacant rental property which I do not plan on renting again.
Property will be resold or rented in ordinary course of purchaser's business conducted under Pennsylvania Sales Tax Number:
Property will be directly used by purchaser in their (circle one) Manufacturing Operations, Mining Operations, Farming Operations, Dairying Operations, Ship-building Operations, which are performed as a business.
Property will be directly used by purchaser in the production, delivery or rendition of public utility service and/or construction, alteration or maintenance of public utility facilities other than buildings. Purchaser presently has on file with the Pennsylvania Public Utility Commission the following Tariff or Rates [click to enter additional needed information]:

Enter full designation of latest Tariff or Rates:
PA P.U.C. No.:
Supplement:

Property will be used in organization or institutional activities by purchaser which is a [click to specify]:

Not Applicable

Religious Organization

Volunteer Fireman's Organization

Non-Profit Educational Institution

Charitable Organization holding Charitable Exemption Number:

Other Purpose - Example: barn, personal garage, etc:

By checking this box, I hereby am providing my digital signature of this form.