EXEMPTION CERTIFICATE
ITEMS OF TANGIBLE PERSONAL PROPERTY AND LABOR
USED IN RESEARCH OR DEVELOPMENT
This is to certify that purchases of tangible personal property or labor on or after ________ (date) from ________ (Selling Dealer's Business Name) will be directly and solely used in research or development activities, as provided in Section 212.052, F.S. These research or development activities are located at:
______________________________________________________
(Street)
______________________________________________________
(City and State)
I understand that if I fraudulently issue this certificate to evade the payment of tax, I will be liable for payment of the tax plus a penalty of 200% of the tax and be liable for fine and punishment provided by law for conviction of a felony of the third degree, as provided in Section 775.082, 775.083 or 775.084, F.S.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true to the best of my knowledge and belief.
_______________________________ ___________________________________________________________
Purchaser's Name (Print or Type) Purchaser's Address
_______________________________ ___________________________________________________________
Signature and Title Florida Sales and Use Tax Number (if applicable)
_______________________________ ___________________________________________________________
Date Federal Employer's Identification Number
(if applicable)
AFFIDAVIT
MACHINERY AND EQUIPMENT USED IN RESEARCH OR DEVELOPMENT
I, the undersigned individual, hereby declare that the purchase(s) or lease(s) of machinery and equipment, including materials and labor used in the self-fabrication of machinery and equipment, on or after ________ (date) from ________ (Selling Dealer's Business Name), will be used predominantly in research or development activities, as provided in Section 212.08(18), F.S.
These research or development activities are located at:
______________________________________________________
(Street)
______________________________________________________
(City and State)
I understand that if I fraudulently issue this affidavit to evade the payment of Florida sales tax, I will be liable for payment of the tax plus a penalty of 200% of the tax and be subject to conviction of a third degree felony.
Under penalties of perjury, I declare that I have read the foregoing affidavit and that the facts stated in it are true to the best of my knowledge and belief.
______________________________________________________
Purchaser's Name (Print or Type)
______________________________________________________
Signature and Title
______________________________________________________
Date
Fla. Admin. Code Ann. R. 12A-1.043
Rulemaking Authority 212.052(5), 212.08(18)(c), 212.18(2), 213.06(1) FS. Law Implemented 212.02(4), (7), 212.052, 212.06(1), 212.08(18), 212.085, 212.12(12) FS.
New 10-7-68, Amended 1-7-70, 6-16-72, 1-19-74, 12-26-83, Formerly 12A-1.43, Amended 1-2-89, 2-28-90, 3-20-96, 7-27-99, 10-2-01, 9-15-08, 12-31-20.