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Name of purchaser <br />Legacy Christian Academy <br />Business address City <br />3037 Bunker Lake Boulevard N.W. Andover <br />Purchaser's tax ID number State of Issue <br />41020 <br />If no tax ID number, <br />MINNESOTA• REVENUE <br />Certificate of Exemption <br />Purchaser: Complete this certificate and give it to the seller. <br />ST3 <br />Seller: If this certificate is not fully completed, you must charge sales tax. Keep this certificate as part of your records. <br />This is a blanket certificate, unless one of the boxes below is checked, and remains in force as long as the purchaser continues making <br />purchases, or until otherwise cancelled by the purchaser. <br />Check if this certificate is for a single purchase and enter the related invoice/purchase order # <br />If you are a contractor and have a purchasing agent agreement with an exempt organization, check the box to make multiple <br />purchases for a specific Job. Enter the exempt entity name and specific project: <br />Exempt entity name _ Project description <br />0. <br />0. <br />enter one of the following: <br />hT <br />Name of seller from whom you are purchasing, leasing or renting <br />Seller's address <br />FEIN <br />41-1868252 <br />Minnesota <br />Driver's license number/State Issued ID number <br />state of Issue <br />number <br />State Zip code <br />MN 55304 <br />City State Zip code <br />Type of business. Circle the number that describes your business. <br />01 Accommodation and food services <br />02 Agricultural, forestry, fishing, hunting <br />03 Construction <br />04 Finance and insurance <br />05 Information, publishing and communications <br />06 Manufacturing <br />07 Mining <br />08 Real estate <br />09 Rental and leasing <br />10 Retail trade <br />11 Transportation and warehousing <br />12 Utilities <br />13 Wholesale trade <br />14 Business services <br />15 Professional services <br />16 Educationnd health-care services <br />17. <br />18 <br />19 <br />20 <br />Nonprofit organization <br />Government <br />Not a business (explain) <br />Other(explain) 1�+v"',^1fa�(�z""� <br />Reason for exemption. Circle the letter that identifies the reason for the exemption. <br />c A Federal government (department) <br />cB Specific government exemption (from list on back) <br />E <br />a0 <br />m C Tribal government (name' <br />m <br />D Foreign diplomat # <br />0 E Charitable organization # <br />c Educational organization # 41020 <br />rx <br />G Religious organization # <br />H Resale <br />®. <br />.• m <br />c <br />btl " <br />N <br />I Agricultural production <br />J Industrial production/manufacturing <br />K Direct pay authorization <br />L Multiple points of use (services, digital goods, or computer <br />software delivered electronically) <br />M Direct mall <br />N Other (enter number from back page) <br />0 Percentage exemption <br />❑ Advertising (enter percentage) <br />❑ Utilities (enter percentage) <br />❑ Electricity (enter percentage) <br />1 declare that the information on this certificate is correct and complete to the best of my knowledge and belief. (PENALTY If you try <br />to evade paying sales tax by using an exemption certificate for items or services that will be used for purposes other than those being <br />claimed, you may be fined $100 under Minnesota law for each transaction for which the certificate is used.) <br />Signatu a of orized purc ser Print name here Title Date <br />Dr. Chris Pellant President 1/8/2014 <br />Rev. 12/13 <br />Forms and fact sheets are available on our website at www.revenue.state.mn.us <br />