Certificate of Exemption

Phone

This field is for validation purposes and should be left unchanged.

Start with your contact information. These details are for Dohrmann follow-up only and are not printed on the official ST3.

Name(Required)

Email(Required)

Phone(Required)

Certificate ID

Enter the purchasing business or organization as it should appear on the certificate. This is usually a company name, not the contact name from the previous page.

Name of purchaser(Required)

Business address(Required)

Street Address Address Line 2 City State ZIP Code

Purchaser’s tax ID number

Minnesota tax ID if you have one. If you do not, use FEIN or a driver’s license / state ID below.

State of issue

FEIN

Required if you do not have a tax ID number.

Driver’s license / state ID #

License state of issue

This is a blanket certificate unless you check one of the boxes below. A blanket certificate stays in force as long as you continue making purchases, or until you cancel it.

Single purchase

This certificate is for a single purchase

Invoice or purchase order number

Contractor / purchasing agent

I am a contractor with a purchasing agent agreement with an exempt organization, making purchases for a specific job

Exempt entity name

Project description

This certificate is issued to Dohrmann Enterprises as the seller. These fields are filled in for you.

Name of seller

Seller’s address

City

State

ZIP code

On the next page you will review your answers and complete the required declaration before submitting.

PENALTY: If you try to evade paying sales tax by using an exemption certificate for items or services that will be used for purposes other than those being claimed, you may be fined $100 under Minnesota law for each transaction for which the certificate is used. This certificate is given to Dohrmann Enterprises (the seller), not the Minnesota Department of Revenue.

Signature of authorized purchaser(Required)

This is stamped on the official ST3 as Signature of Authorized Purchaser.

Print name of authorized purchaser(Required)

Title(Required)

Date(Required)

Please confirm the information below before submitting. The official Minnesota ST3 (page 1) will be filled and emailed to Dohrmann Enterprises.

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MN ST3 Certificate of Exemption