Clean Indoor Air Act Exception Renewal Sales Information Form Exception Expiration Date: Form Must Be Received By: Exception Type: Drinking Establishment Type I *** Additional guidance for completing this form can be found on the reverse 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the 'Business Name' and 'Exception ID' at the top of the form. Ensure that these details match your current exception certificate.
  3. Fill in the 'Trade Name' and 'Sales and Use Tax ID (STLN)' fields. If you are unsure about your STLN, refer to your previous filings.
  4. Complete the 'License Identification (LID) #' and 'Entity ID (EIN)' sections accurately.
  5. Report your actual sales information for the previous 12 months in the designated fields, rounding to the nearest dollar. Follow the instructions for monthly, quarterly, or semi-annual filers as applicable.
  6. Indicate your method of filing sales to the Department of Revenue by checking the appropriate box for Monthly, Quarterly, or Semi-Annually.
  7. Sign and date the affidavit of preparer section at the bottom of the form, ensuring all information is true and correct.

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