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Commonwealth of Puerto Rico DEPARTMENT OF THE TREASURY Form AS 2914.1 D Rev. Sep 6 13 Serial Number APPLICATION FOR EXEMPTION CERTIFICATE FOR MANUFACTURING PLANTS Check one: New Application Renewal INFORMATION OF THE COMMERCIAL LOCATION In order to process your application, you must complete line 1. 1. Merchant’s registration number 2. Social Security or Employer Identification Number Receipt Stamp 3. Legal name of the corporation, partnership, individual owner (name, initial, last name) or other 4. Commercial name or DBA 6. Municipality where you filed the Volume of Business 5. Volume of business for the municipality where this location is established, according to the Volume of Declaration for this location Business Declaration for the payment of the $ Municipal License Tax, prior to this application: , , . 7. If this is a "New Application", check here if you submitted to the Department of the Treasury stamped copy of the Volume of Business Declarations for the payment of the Municipal License Tax or the Provisional Municipal License Tax Application for the municipality where the new location or activity is established. (If this application is a "Renewal", do not complete this line and refer to line 8) 8. If this is a “Renewal”, check here if you submitted to the Department of the Treasury stamped copy of the Volume of Business Declarations for the payment of the Municipal License Tax for all the municipalities where you conduct business. 9. Provide a detail of the type of tangible personal property that is purchased in the manufacturing process. 10. Indicate if you qualify as a manufacturing plant under Section 4030.06 of the Puerto Rico Internal Revenue Code of 2011: OATH Yes No I hereby declare under penalty of perjury that this application has been examined by me, and that to the best of my knowledge and belief, all the information provided herein is true, correct and complete. I also agree to notify the Secretary of the Treasury of any change in the information provided on this application, within 30 days of the change or event. The declaration of the person that prepares this application (except the merchant) is with respect to the available information, and such information has been verified. Merchant's name Merchant's signature Title Date Name of duly authorized agent Signature of duly authorized agent Date Specialist's number Address Telephone TO BE COMPLETED BY THE DEPARTMENT OF THE TREASURY Verified information regarding this application, as applicable: Failure to file income tax returns or other returns for the last five years Income tax or other tax debt Failure to file SUT returns SUT debt Volume of Business Declarations for the payment of the Municipal License Tax of all municipalities where he/she conducts business Any other document required by the Secretary of the Treasury _______________________________________________________________________ Determination: Comments / Observations: Accepted Denied CERTIFICATION After evaluating this application, I certify that it is complete in all of its parts and the information provided herein is presumed to be true. Nevertheless, the Department of the Treasury reserves the right to conduct any future investigation to verify the information. Employee's name Retention: Six (6) years. Employee's signature Date District INSTRUCTIONS This form shall be filed for each location of every duly registered merchant, who is a manufacturing plant according to Section 4030.06 of the Puerto Rico Internal Revenue Code of 2011, as amended (Code). This form shall be completed in all of its parts in a clear and legible manner. Presenting an incomplete form may delay the evaluation of your case and the issuance of the exemption certificate. When issuing the exemption certificate, the Secretary of the Treasury (Secretary) shall ensure that the person requesting such certificate provides evidence of compliance with the following accreditation criteria: (1) Is a holder of an exemption as established in this part; (2) Is duly registered at the Merchant’s Registry of the Department of the Treasury (Department); (3) Does not have any debt with the Department; (4) Has filed all of his/her returns, including the income tax returns and those related to the sales and use tax; and (5) Provides the Volume of Business Declarations for the payment of the municipal license tax for all municipalities where he/she conducts business; The Secretary may require a person to submit documents and evidence of its organizational structure, tax debt certifications or any other information or necessary document during the review process. Furthermore, the Secretary may revoke the exemption certificate to any person that fails to comply with any of the requirements established in Subtitle D of the Code. Any person whose exemption certificate has been revoked, may request a new exemption certificate one year after such revocation, subject to the previously indicated requirements. Any person that violates the provisions of Subtitle D of the Code, the requirements set forth by the Secretary or the regulations issued thereunder, will be subject to administrative and criminal sanctions, as it is determined. Therefore, the information provided shall be true, correct and complete. This application will be filed at any of the Taxpayer’s Service Centers located in Aguadilla, Arecibo, Bayamón, Caguas, Mayagüez, Ponce, San Juan (Intendente Ramírez Building) and Hato Rey (Mercantil Plaza Building). For the addresses of the Centers please call (787) 7220216. It may also be mailed to the Department of the Treasury, Taxpayer’s Service Bureau, Exemption Certificate, PO Box 9024140, San Juan, PR 00902-4140.