before me
personally appeared
The construction contract must explicitly provide for the transfer of title to the materials prior to the time the materials are installed and
The construction contract must separately state the price of materials exclusive of the charge for installation
The construction contractor must obtain an exemption certificate from the Indian purchaser
The construction contractor must provide a valid and timely resale certificate to its vendor
The contract must specifically provide that ownership of the materials (title) will transfer to the Indian customer in Indian country prior to
The contractor must be in the business of selling materials or other tangible personal property;
The contractor must possess a valid seller s permit;
The materials must in fact be delivered to the Indian purchaser in Indian country; and
(ADDRESS (street city zip code))
(CITY)
(Clear page button) CLEAR
(DATE OF DELIVERY)
(date)
(DATE)
(DAYTIME TELEPHONE NUMBER)
(Description of property purchased)
(DESCRIPTION OF PROPERTY)
(DRIVER LICENSE NUMBER OR OTHER STATE ID)
(INVOICE OR CONTRACT NUMBER)
(NAME (please print))
(name and title)
(NAME OF PURCHASER (please print))
(name of purchaser or purchaser s representative)
(NAME OF RESERVATION)
(name of seller or seller s representative)
(NAME OF SELLER)
(print button) PRINT
(SELLER S PERMIT NUMBER)
(STATE)
(STREET ADDRESS)
(to be completed by California notary public or authorized tribal representative)
(to be completed by purchaser)
(to be completed by seller)
(ZIP CODE)
a common carrier or a contract carrier you do not need to complete the Statement of Delivery or the Notary Statement Instead you should
a duly authorized tribal official or his or her designee If you are delivering the property to the Indian purchaser in Indian country by utilizing
ADDRESS (street city zip code)
An Indian residing in Indian country; or An Indian organization in Indian country
As a consumer tax generally applies to sales of materials to contractors who are not Indians This is true even when the materials are
be furnished and installed in the performance of a construction contract Please provide a complete description of the property purchased
BOE 146 CC (BACK) (3 11)
BOE 146 CC (FRONT) (3 11) STATE OF CALIFORNIACONSTRUCTION CONTRACT EXEMPTION CERTIFICATEBOARD OF EQUALIZATIONAND STATEMENT OF DELIVERY IN INDIAN COUNTRY
certificate for multiple transactions will require proof of delivery of the property in Indian country for each transaction
construction contract separately stating the sales price of the materials in addition to documentation showing transfer of ownership and
construction contractor meets the requirements outlined above allowing the construction contractor to act as a retailer of materials) that will
correct WITNESS my hand and official seal (if applicable)
country along with a contract of sale or other sales agreement specifically showing title passing to the Indian purchaser in Indian country
County of
DATE OF DELIVERY
DAYTIME TELEPHONE NUMBER
delivered in Indian country and permanently attached to real estate in Indian country
Delivery and Notary Statement is not required Instead the retailer should retain a bill of lading or other documents showing delivery in Indian
delivery of the property to the Indian customer in Indian country The Notary Statement may be completed by a California notary public or by
delivery of the property to the Indian purchaser in Indian country If the property is delivered by facilities of the retailer proper completion of
DESCRIPTION OF PROPERTY
DESCRIPTION OF PROPERTY PURCHASED
DRIVER LICENSE NUMBER OR OTHER STATE ID
executed the instrument
EXEMPTION CERTIFICATE
Fraudulent use of this statement to avoid the payment of California sales and use tax can result in severe penalties
from tax as a sale to an Indian purchaser in Indian country provided each of the following requirements are met:
Generally construction contractors are consumers of materials that are furnished and installed in the performance of a construction contract
I certify under penalty of perjury under the laws of the State of California that the foregoing paragraph is true and
I have delivered the above described tangible personal property to the purchaser named above
I hereby certify that the property described below is being purchased for use in Indian country and I am:
I hereby certify under penalty of perjury under the laws of the State of California that the below described materials fixtures or other tangible
If you are delivering the materials or fixtures to the Indian purchaser in Indian country by your own facilities you may utilize this Statement
If you intend to use this exemption certificate as a blanket exemption certificate to cover multiple transactions please indicate this by
including all tangible personal property in the description of property purchased field below Please note that the use of a blanket exemption
Indian purchaser occurred in Indian country If the property is delivered via common carrier or contract carrier completion of the Statement of
INVOICE OR CONTRACT NUMBER
meeting each of the following requirements:
must separately state the sales price of the materials exclusive of the charges for installation; and
NAME (please print)
NAME OF PURCHASER (please print)
NAME OF RESERVATION
NAME OF SELLER
NOTARY STATEMENT
NOTE TO SELLER AND PURCHASER
NOTICE TO SELLER
occurred in Indian country The section labeled Exemption Certificate may be used to document that the property was sold to an Indian
of Delivery to document delivery in Indian country It is recommended that you also complete the Notary Statement below to document
ownership transferred in Indian country prior to installation
personal property was delivered to the purchaser in Indian country on the date and at the place stated below
purchaser residing in Indian country Completion of this section in full by an Indian purchaser will provide the construction contractor with
PURCHASER S SIGNATURE DATE
retain your bill of lading or other shipping documents as proof of delivery in Indian country along with your construction contract indicating
Sales tax generally does not apply to the sale of fixtures to non Indian contractors furnish and install the fixtures in Indian country
SELLER S PERMIT NUMBER
Signature
STATE
State of California
STATEMENT OF DELIVERY
STREET ADDRESS
sufficient documentation that the property was sold to an Indian residing in Indian country The construction contractor must also have a
that by their signature(s) on the instrument the person(s) or the entity upon behalf of which the person(s) acted
the Statement of Delivery and Notary Statement may serve as documentation that transfer of ownership and delivery of the property to an
the within instrument and acknowledged to me that they executed the same in their authorized capacity and
This document may be used to document that the sale was to an Indian purchaser residing in Indian country and/or to document that delivery
Under certain specific circumstances a construction contractor performing a construction contact may qualify as a retailer of materials by
use or installation of the materials
When accepted in good faith this exemption certificate may be used for the purchase of fixtures and materials (but as to materials only if the
When the construction contractor qualifies as a retailer of materials the retail sale of the materials by the contractor may qualify as exempt
who proved to me on the basis of satisfactory evidence to the person(s) whose name(s) is/are subscribed to
Y SEALARNOT(if applicable)
ZIP CODE