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Agricultural Exemption Certificate

Purchaser's Exemption Certificate for Electricity Used Directly and Exclusively in Production or Processing of Agriculturer Products on a Farm

I certify that the electricity purchased on or after from gulf Coast Electric Cooperative will be used directly and exclusively for production of processing of agricultural farm products on a farm and is exempt from sales tax pursuant to Section 212.08(5)(e)2., Florida Statutes.

I understand that if the electricity purchased does not qualify for exemption under Section 212.08(5)(e)2., Florida Statutes, that I must pay the tax on the purchase directly to the Department of Revenue.

I understand that if I fraudulently issue this certificate to evade the payment of sales tax I will be liable for payment of the sales tax, plus a mandatory penalty of 200% of the tax and will be liable for fine and punishment provided by law for conviction of a felony of the third degree, as provided in s. 775.082, s. 775.083, or s. 775.084, F.S.

Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.


    • I have read and understand the above paragrah. *

    • Date *

    • Purchaser's Name *


    • Purchaser's Address *







    • Signature and Title *

    • Account Number(s) *


Authentication Text*
(Enter the text in the image above into this field.)

NOTE: Do Not Alter These Fields: