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1 |
Name Of Seller:
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Your E-mail
Address:
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2 |
Buyer/Business:
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3 |
Address of
Buyer:
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City, State, Zip:
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4 |
Buyer UBI/Revenue
Registration #:
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5 |
Buyer is in
Business of:
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6 |
Types of Items
Purchased for
Resale:
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I (the buyer)
certify that I
am purchasing
the items on
line 6
(Please Check
Appropriate Box) |
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7 |
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For resale in
the regular
course of
business without
intervening use
in the regular
course of
business. |
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8 |
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For use as an
ingredient or
component part
of a new article
of tangible
personal
property to be
produced for
sale. |
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9 |
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As a chemical to
be used in
processing a new
article of
tangible
personal
property to be
produced for
sale, or... |
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10 |
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For use as feed,
seed, seedlings,
fertilizer, or
spray materials
in my capacity
as a farmer. |
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I acknowledge
that I am solely
responsible for
purchasing
within the
categories
listed on line
6. I acknowledge
that misuse of
the resale
privilege
claimed by use
of this
certificate
subjects me to a
penalty of 50
percent of the
tax due, in
addition to the
tax, interest,
and any other
penalties
imposed by law.
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Print Name |
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Effective Date: |
Through
(Not to exceed 4
years) |
