1. Name of Seller:
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2. Name of Buyer/Business:
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3. Address of Buyer:
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4. Buyer's UBI / Revenue Reservation No.
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5. Buyer is in the 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 listed on line 6 (please check the appropriate box):
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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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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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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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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 addtion to the tax, interest, and any other penalties imposed by law.
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Print Name: |
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Signature: |
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Effective Date: |
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