Michigan Sales and Use Tax Certificate of Exemption

Michigan Sales and Use Tax Certificate of Exemption

Michigan Department of Treasury 3372 (Rev. 01-21)
This exemption claim should be completed by the purchaser, provided to the seller, and is not valid unless the information in all four sections is complete. Do not send a copy to Treasury unless one is requested.
SECTION 1: TYPE OF PURCHASE

Check one of the following:
One-Time PurchaseBlanket Certificate. Recurring Business Relationship.Blanket Certificate. Expires
Order or Invoice Number*
Expiration Date (maximum of four years)*

MonthDayYear
Date
The purchaser completing this form hereby claims exemption from tax on the purchase of tangible personal property or services purchased from the seller named below. This claim is based upon: the purchaser’s proposed use of the property or services; OR the purchaser’s exempt status.
Seller’s Name and Address*

SECTION 4: CERTIFICATION
I declare, under penalty of perjury, that the information on this certificate is true, that I have consulted the statutes, administrative rules and other sources of law applicable to my exemption, and that I have exercised reasonable care in assuring that my claim of exemption is valid under Michigan law. In the event this claim is disallowed, I accept full responsibility for the payment of tax, penalty and any accrued interest, including, if necessary, reimbursement to the vendor for tax and accrued interest.
Business Name*
Address*

Business Address

Street Address Line 2

City, State, ZIP CodeState / Province

Postal / Zip Code
Type of Business*
Other (enter code and write in business type):*
Business Telephone Number*
Name:*
Title:*
Signature:*

Clear
Date Signed:*

MonthDayYear
Date
Should be Empty: