Form AS 2914.1 H - Departamento de Hacienda de Puerto Rico

Serial Number
Commonwealth of Puerto Rico
DEPARTMENT OF THE TREASURY
Form AS 2914.1 H
Rev. Sep 26 13
APPLICATION FOR MANUFACTURER WAIVER
Check one:
New Application
Renewal
INFORMATION OF THE COMMERCIAL LOCATION
In order to process your application, you must complete the form in all of its parts.
1. Merchant’s registration number
2. Social Security or Employer Identification Number
Receipt Seal
3. Legal name of the corporation, partnership, individual owner (name, initial, last name) or other
4. Commercial name or DBA
5. Indicate if you qualify as a manufacturing plant under Section 4010.01(cc) of the Puerto Rico Internal Revenue Code of 2011:
Yes
No
6. Indicate the manufacturer identification number: ___________________________________
7. Indicate the average of sales made to Qualified Resellers:
%
8. Provide a general description of the taxable items manufactured and a description of any other tangible personal property acquired by the Manufacturing Plant
for resale, including information regarding the sales of the products manufactured and the sales of the products acquired for resale, for the year immediately
preceding the date of this application. Also include a segregation percentage calculated from the sales of the taxable items, by product category, and the
total sales. (If you need additional space, submit a schedule).
Type of Taxable Item Manufactured
Total Sales of the Type of Taxable Item Manufactured
Segregation Percentage between Sales of the
Taxable Item Manufactured and Total Sales
Other Taxable Items Acquired for Resale
Total Sales of Products Acquired for Resale
Segregation Percentage between Sales of the
Taxable Item Acquired for Resale and Total Sales
Retention: Six (6) years.
Continue on back.
Form AS 2914.1 H
Page 2
Rev. Sep 26 13
The merchant must notify the Secretary of the Treasury of any change in the information provided on this application,
within 30 days, after the change or event.
OATH
I hereby declare under penalty of perjury:
. That I am a duly registered merchant;
. That I am a Manufacturing Plant, as such term is defined in Section 4010.01(cc) of the Code;
. That I have a manufacturer identification number and it is in effect;
. That at least eighty percent (80%) of my sales are made to resellers that own a Provisional Reseller Certificate, Reseller Certificate or Eligible Reseller
Certificate issued under Section 4050.04 or Section 4030.02 of the Code, respectively; and
. That I have examined the information included on this Application, schedules and documents attached, and that the same is true, correct and complete.
Merchant’s name
Merchant’s signature
Title
Date
Name of duly authorized agent
Signature of duly authorized agent
Date
Specialist’s number
Address
Telephone
Affidavit No. _________________
NOTARY
SEAL
Sworn and subscribed before me by __________________________, of legal age, ________________ [civil status], ___________________ [occupation],
and resident of ______________________, __________, personally known to me or identified by means of_____________________________________,
at ___________________, ___________, this _______ day of _______________________, _______ .
____________________________________________
Name of the Notary Public
____________________________________________
Signature of the Notary Public
TO BE COMPLETED BY THE DEPARTMENT OF THE TREASURY
Verified information regarding this application, as applicable:
Income tax returns for the last five years were not filed, including other returns
Income tax debt or debt with regards to other concepts
SUT returns were not filed
SUT debt
Volume of Business Declarations for the payment of the Municipal License tax filed with all municipalities where he/she conducts business
Is not registered in the Department as a Manufacturing Plant
Any other document required by the Secretary of the Treasury _____________________________________________________________________
Determination:
Accepted
Denied
Comments / Observations:
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 by every person engaged in the manufacturing of any taxable item that wishes to request and obtain a
waiver from the collection, withholding and deposit of the sales and use tax (SUT) in the sales of taxable items by a manufacturer
to a wholesale distributor. For purposes of Section 4020.05(a)(2) of the Puerto Rico Internal Revenue Code of 2011, as amended
(Code), the term “wholesale distributor” has the same meaning of the term “Wholesaler” under Section 4010.01(w) of the Code
and includes a merchant registered that is a “retail dealer” or “retailer”, as defined in Section 3050.01(a)(1)(C) of the Code, or the
combination of both. It is important to point out that the term “retail dealer” or “retailer” does not include a merchant whose
principal business activity is to provide services, regardless that he/she acquires tangible personal property in order to carry
out such services. The application 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 manufacturer waiver.
When issuing the manufacturer waivers, the Secretary of the Treasury (Secretary) shall ensure that the person requesting such
waiver provides evidence of compliance with the following criteria:
(1) That the merchant is entitled to receive a manufacturer waiver;
(2) That the merchant is duly registered at the Merchant’s Registry of the Department of the Treasury (Department);
(3) That at least eighty percent (80%) of the sales are made to resellers that own a Provisional Reseller Certificate, Reseller
Certificate or Eligible Reseller Certificate issued under Sections 4050.04 and 4030.02 of the Code;
(4) That a general description of the taxable items manufactured and a description of any other tangible personal property
acquired by the Manufacturing Plant for resale, including information regarding the sales of the products manufactured and
the sales of the products acquired for resale, for the year immediately preceding the date of the Waiver application, with a
segregation percentage calculated from the sales of taxable items, by product category, and total sales, was provided;
(5) That the merchant does not have any debt with the Department; and
(6) That the merchant has filed all of his/her returns, including the income tax returns and those related to the sales and use tax,
and provided copies of the Volume of Business Declarations for the payment of the municipal license tax of all municipalities
in which the merchant conducts business.
During the review process, the Secretary may require a person or entity to submit documents and evidence of its organizational
structure, tax debt certifications or any other necessary information or documentation. Furthermore, the Secretary may revoke
the manufacturer waiver to any holder of such waiver, if he determines that the applicant is not a Manufacturing Plant and does
not meet the required sales percentage to Qualified Resellers, or if the Department’s registries reflect that the applicant has not
paid any tax, including withholdings, or has failed to file any return, form or declaration. Nevertheless, the applicant may present
documentation to demonstrate that there is no unfulfillment or evidence of a payment plan with the Department for any tax owed,
including withholdings.
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 shall be sworn before a notary public and will be filed at the following address: Department of the
Treasury, Sales and Use Tax Bureau, Mercantil Plaza Building, Ponce De León Avenue, Stop 27½, San Juan, PR. For
additional information you may contact the Department of the Treasury at (787) 722-0216, option no. 8, visit any of the Taxpayer’s
Service Centers or refer to the provisions of Internal Revenue Circular Letter No. 13-12.