UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX...

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UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable, subject to the notes on pages 2-4. The issuer and the recipient have the responsibilitv of determining tl.re proper use of this certificate under applicable laws in each state, as these nray change flom time to time lssued to Seller: cENERAL CABLE INDTJSTRIES. ]NC. DBA GEPCo INTERNATIONAL Address: 1770 BIRCHWOOD AVENUE. DES PLAINES. IL 600i8 I cer1iry- that: Name of Firrn (Buyer): Address; and is registered with the belo,'v listed states and cities \\'ithin r.vhich your firm rvould deliver purchases ro us and that any such purcha^ses are for whoiesale, resale, ingredients or components ofa new product or serr,icel to be rcsold. leased. or rented in the nomtal course ofbusiness. We arc in the business of wholesaling, retailing. manufacturing, leasing (renting) the following: Dcscrintion of Business : General description oftangibLc properry- or ta\able services to be purch:r-sed lrom the seller is engagcd as a registered I Wholesaler I I Keta ller f Manufacturer -^., | | Seller (Lalrtornta) r--r , Ll Lcssor (see notcs on pages 2-41 T-"] ^ , I I Urndr { )Dccil\ ) liiBst* At-- AR A?.1: CA] cor LI DC5 cAo LII I,7 iD ]LI'E IA KS KY2] ME9 MDIO MI,, MNI2 $txar f4rgi*lr*{i**" S*{1*r*r fl*rriait, *r X{} \unrfo+r lf *"urrh***r $tute -\lntelteEislra{i*n.Scll+r liun"l I'rr rrf P*a.cfu &s*r MOrr ; f*rmi*n on ll) NV N.l NM1.15 NL) oH25 or26 RIIT SC sD16 TN l-x re UT VT wA20 wl2r I lur-ther certif) that if any properl'or service so purchzu;ed tax tlee is used or c:onsumed by the firnt as to nta.ke it subject to a Sales or use Tar rvc ivill pay the fa\ due directly Io the proper taxing authoritl'when state laiv so provides. Under penalties of perjurv, I su'ear or affirm that the infbrmation on this lbrm is true and correct as lo everv materiai ntattt'r. Authorized Signature: __ l'itle Date Re,-i.sed 0612008 I'age I o.{l (Orvner, Partncr or Crtrporatc C)tf rccr')

Transcript of UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX...

Page 1: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION

The below-listed states have indicated that this form ofcertificate is acceptable, subject to the notes on pages 2-4. The issuer and therecipient have the responsibilitv of determining tl.re proper use of this certificate under applicable laws in each state, as these nraychange flom time to time

lssued to Seller: cENERAL CABLE INDTJSTRIES. ]NC. DBA GEPCo INTERNATIONAL

Address: 1770 BIRCHWOOD AVENUE. DES PLAINES. IL 600i8

I cer1iry- that:

Name of Firrn (Buyer):Address;

and is registered with the belo,'v listed states and cities \\'ithin r.vhich your firm rvould deliver purchases ro us and that any such purcha^ses are forwhoiesale, resale, ingredients or components ofa new product or serr,icel to be rcsold. leased. or rented in the nomtal course ofbusiness. We arc inthe business of wholesaling, retailing. manufacturing, leasing (renting) the following:

Dcscrintion of Business :

General description oftangibLc properry- or ta\able services to be purch:r-sed lrom the seller

is engagcd as a registered

I Wholesaler

I I Keta llerf Manufacturer-^.,| | Seller (Lalrtornta)r--r ,Ll Lcssor (see notcs on pages 2-41T-"] ^ ,I I Urndr { )Dccil\ )

liiBst*

At--ARA?.1:CA]corLI

DC5

cAoLII

I,7

iD]LI'EIAKSKY2]ME9MDIO

MI,,MNI2

$txar f4rgi*lr*{i**" S*{1*r*r fl*rriait, *r X{}\unrfo+r lf *"urrh***r

$tute -\lntelteEislra{i*n.Scll+rliun"l I'rr rrf P*a.cfu &s*r

MOrr

; f*rmi*n on ll)

NVN.l

NM1.15

NL)

oH25

or26

RIIT

SC

sD16

TNl-x re

UTVTwA20wl2r

I lur-ther certif) that if any properl'or service so purchzu;ed tax tlee is used or c:onsumed by the firnt as to nta.ke it subject to a Sales or use Tar rvcivill pay the fa\ due directly Io the proper taxing authoritl'when state laiv so provides.

Under penalties of perjurv, I su'ear or affirm that the infbrmation on this lbrm is true and correct as lo everv materiai ntattt'r.

Authorized Signature: __

l'itle

Date

Re,-i.sed 0612008I'age I o.{l

(Orvner, Partncr or Crtrporatc C)tf rccr')

Page 2: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

E-595EWeb-Fill

1-07

Streamlined Sales and Use Tax Agreement

Gertificate of Exemption

This is a muftt-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if theyqualify to claim exemption from tax in ihe state thatwould otherwise be due tax on this sale. The seller may be required to providethis exemption cedificate (or data elements required on the form) to a state that would otherwise be due tax on this sale.

The purchaser will be held liable for any tax and interest, and possibly civil and criminal penafties imposed by the member state,if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-basedexemption on a sale made at a location operated by the seller within the designated state if ihe state does not allow such anentity-based exemption.

1 n Check if you are attaching the Multistate Supplemental form

lnf llf not,enterthetwo-letterpostal abbreviationforthestateunderwhoselawsyouareclaimingexemplon.

| | Check if thrs certificate is for a single purchase and enter the related invoice/purchase order #2

3

Business address Cil/ State Zip code

Purchaser's tax lD number State of issue Country of issue

If no iax lD number, I FEINenter one of the following:

I Driver's lrcense number/Stale rssued lD numoer' slate o//ssue number I

Foreign diplomat number

Name of seller from whom you are purchasrng leasrng. or .entrng

GENERAL CABLE INDUSTRIES, INC, DBA GEPCO INTERNATIONALSeller's address Citv State

L77O BIRCHWOOD AVENUE DES PLAINES iL 60018

4 Type of business. Check the number that describes your business

[ 01 Accommodation and food servicesI O2 eglcultural, forestry, fishing, and hunting[ 03 Constructionfl 0a Finance and insurancef 05 Information, publishing, and communicatjonsf] 06 Manufacturing

I oz naining

I I UU KEAI ESIAIE

[ 09 Rental and leasingI to Retait trade

f] 11 Transportation and warehousingf tz utilitiesI tl Unrotesaletrade[ 1+ Business servicesf 15 Professional servicesf, 16 Education and health-care servicesI t7 Nonprofitorganizationf 18 GovernmentI ts tlotabusiness[] 20 otner @xprain)

5 Reason for exemption. Check the letter that identifies the reason for the exemption

LJ A Federal government @epaftment)

I B State ..::]::: r :- government rnamel

LJ H Agricultural production #

U I Industrial production/manufacturing #

I C Tribal governmenl(name) I L Direct pay permrr #

I D Foreign diplomat # f, X Direct mail #

I t- Olher (exptain)

L_l u Kesate F

6 Sign here. I declare that the information an this ceftificate is correct and complete to the best of my knowtettge anc| beliefSrgnature of authorized purchaser Print name here

Page 3: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

E-595EWeb-Fill

1 -07

Streamlined Sales and Use Tax AgreementCertificate of Exemption

This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if theyqualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to providethis exemption certlficate (or data elements required on the form) to a state that would otheuise be due tax on this sale.

The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state,if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-basedexemption on a sale made at a location operated by the seller within the designated state if the state does not allow such anentity-based exemption.

1 [--} Check if you are attaching the Multistate Supptementat form.

lWV I lf noi, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemptron.

l-l Cfreck if this certificate is fora single purchase and enterthe relaied invorceipurchase order#

Please print

2

3Name of purchaser

Busrness address City Siate Zrp cod€

Purchaser's tax lD number Stale of issue Co!ntry of issue

lf no tax lD number, I FEINenter one ol ihe lollowing:

i Driver's license number/State issued lD number' slale oflssue number

I Forergn diplomat number

Name otsellerfromvr'hom you are purchasing, leasing orren

GENERAL CABLE INDUSTRIES. INC. DBA GEPCO INTERNATIONALSeller's address City

1770 B]RCHWOOD AVENUE DES PLAINESState

IL

Zip code

50018

4 Type of business. Check the number that describes your

[ 01 Accommodation and food senvices

E 02 Agricultural, forestry, fishing, and hunting[J 03 Constructionf] 0+ Finance and insuranceI 05 Information, publishing, and communicatronsLl 06 ManufacturingLl 07 Mining

[_l 08 Real estaten 09 Rental and leasrng| | 10 Retail trade

Transportation and warehousrngUtilitiesWholesale tradeBusiness servicesProfessional servicesEducation and health-care servicesNonprofit organizationGovernmentNot a businessOther (explain)

Direct pay permit #Direct mail #

bUSINESS.

lrrl-l rrl-l ra

Ira[-l tc

[]rofrznreDrgf,zo

5 Reason for exemption. Check the letter that identifies the reason for the exempuon.

Ll A Federal government (depaftment) Lj H Agriculturai production #

I e state governmenl (narneJ LJ I Industrial production/manufacturing #I C Tribal governm ent 6ame1

f] O Foreign diplomat #

Other (explain)

Ll u Kesare F

6 Sign here. I declare that the information an this certiftcate is correct and complete to the best of rny knowledge and bellef

TLlKIr-

Srgnature of aulhonzed pqrchaser Pflnt name here Date

Page 4: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

E-595EWeb-Fill Streamlined Sales and Use Tax Agreement

Certificate of Exemption

This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if theyqualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to providethis exemption certificate (or data elements required on the form) to a state that would otherwise be due tax on this sale.The purchaserwill be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member srare,if the purchaser is not eligible to claim this exemption. A seller may not accept a certificate of exemption for an entity-basedexemption on a sale made at a location operated by the seller wiihin the designated state if the state does not allow sucn anentity-based exemption.

1 n Check if you are attaching the Multistate Supplemental form.

IWY I lf not, enterthe two-letterpostal abbreviation forthestate underwhose laws you are claiming exemption.

I I check if this certificate is for a single purchase and enter the related jnvoice/purchase order #

Please print

2

3Name of purchaser

lf no tax lD number,enter one of the following

Driver's license numberlsiate tssued lD numberslale oflssue number

diplomat number

of seller from asrng, leasrng, or

GENERAL CABLE INDUSTRIES, INC. DBA GEPCO ]NTERNATIONALs aodress Ity tp code

1770 B]RCHWOOD AVENUE DIiC PT,A TNTE C IL 50018

4 Type of business. Check the number that describes your busi

[ 01 Accommodation and food servicesf 02 Agricultural, forestry, fishing, and huntingLl 03 Construction[l 04 Finance and insuranceI 05 Informatlon, publishing, and communicatlonsL-_l 06 ManufacturingLJ 07 MiningLi 08 Real estateLJ 09 Rental and leasingl__l 10 Retail trade

I tgs5-

trrt7ttf-l ralJ,vIra[-l rcLI 'JXrofjttlrel*-l roIJ'v

L]ZU

Transportation and warehousingUtilities\&holesale tradeBusiness servicesProfessional servicesEducation and health-care servrcesNonprofrt organizationGovernmentNot a businessOther (explain)

Direct pay permit #

5 Reason for exemption. Check the letter that identifres the reason for the exemotion

I n Federal government @epartment)

fJ g state ...,i,.:;:.ar.:government rname)

I C Tribal governm enl fiame)

X n Agricultural production #I ndustrial production/manulacturing #Il

lLI O Foreign diplomat # Direct mail #

Other (explain)

i I (, xesate+

6 Sign here. I declare that the information on this cerTificate is correct ancl contplete to the best of my knowtedge and belief

Irlr-

Signaiu16 of authorized purchaser Print name here

Page 5: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

-/1+I@v

York State Department of Taxation and Finance

Resale Certificate

I Single-use certificate D Blanket certificate Date issuedTemporary vendors must issue a single-use certificate

ST'120 rorgsi

I am engaged in the business of and principally sell(Contractors may not use this cerlificate to purchase materials and supplies.)

Part 1 - To be completed by registered New York State sales tax vendorsI certify that I am:I a New York State vendor (including a hotel operator or a dues or admissions recipient), show vendor or entertainment vendor. My

valid Certificate of Authoritv Number is

I a New York State temporary vendor. My valid Certificate of Authority Number is and exprres on _

I am purchasing:A I Tangible personal property (other than motor fuel or diesel motor fuel)

r for resale in its present form or for resale as a physical component part of tangible personal property;o for use in performing taxable services where the property will become a physical component part of the property upon which

the services will be perforrned, or the property will actually be transferred to the purchaser of the taxable service inconjunction with the performance of the service, or

n A service for resale, including the servicing of tangible personal property held for sale.@,

Part 2 - To be completed by non-New York State purchasersI certify that I am not registered nor am I required to be registered as a New York State sales tax vendor. I am reqistered to collect salestax or value added tax (VAT) in the following stateljurisdiction and havebeen issued the following registration number . (lf sales tax or VAT registration is notrequired and a registration number is not issued by your home jurisdiction, indicate the location of your business and write nat appticableon lhe line requesling the registration number.)

I am purchasing:C fl Tangible personal property (other than motor fuel or diesel motor fuel) for resale, and it is being delivered directly by the seller to

my customer or to an unaffiliated fulfillment services provider in New York State.D n Tangibie personal property for resale that will be resold from a business located outside New York State.

Part 3 - Certificationl, the purchaser, understand that:

I I may not use this certificate to purchase rtems or services that are not for resale.r lf I purchase tangible personal property or services for resale, but I use or consume the tangible personal property or services

myself in New York State, I must report and pay the unpaid tax directly to New York State.r I will incur tax liabilities, in addition to penalty and interest, for any misuse of this certificate.

Please type or print

Sefler information - please type or printSeller's name

GENERAL CABLE INDUSTzuES.INC. DBA GEPCO INTERNATIONALAddress

I 770 I]IRCTIWOOD AVE}.]LIECrty

DES PLAINESState

ILZIP code

60018

Purchaser information - please type or print

Purchaser's name as it appears on the sales tax registration Name of owner, partner, or offlcer of corporation, aulhorizing the purchase

Street address Purchaser's signature

Gity State Zlp code Title

Substantial p€nalties will result from misuse of this certificate.

Page 6: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

Form ST-10COM MONWEALTH OF VIRGINIA

SALES AND USE TAX CERTIFICATE OF EXEMPTION

16; GENER\L CABLE INDUSTRIES, II'lC. DBA GEPCO INTERNATIONgfIs(Name of suppli€r)

LJIO BIRCIIWOOD AVEN]UE DES PI-AINES

(For use by a Virginia dealer who purchases tangible personal property for resale,or for lease or rental, or who purchases materials or containers

to package tangible personal property forsale)

iL 6001E(Number and street or tural route) (City, town, or post offlce) (State) (ZlP Code)

The Virginia Retail Sales and Use Tax Act provides that the Virginia sales and use tax shall not apply to tangible personalproperty purchased for resale; that such tax shall not apply to tangible personal property purchased for future use by a person fortaxable lease or rental as an established business or part of an established business, or incidental or germane to such busrness,including a simultaneous purchase and taxable baseback. The Aci provides also that such tax shall not apply to packaging mater-ials such as containers labels, sacks, cans, boxes, drums or bags if the materials are marketed with a product being sold and becomethe property of the purchaser

This Certificate of Exemption may not be used by a using or consuming construction contractor as defined in the Regulations.

The undersigned dealer hereby certifies that all tangible personal properly purchased from the above named supplier onand after this date will be purchased for the purpose indicated below, unless otherwise specified on each order, and that thisCertificate shall remain in effect until revoked in writing by the Department of Taxation (Check proper box below.)

I | 1. Tangible personal property for RESALE only

I Z Tangible personal property for future use by a person for taxable LEASE OR RENTAL as an established business,or part of an established business, or incidental or germane to such business, or a simultaneous purchase andtaxable leaseback.

L-.'] 3. Packaging materials such as contarners, labels, sacks, cans, boxes. drums or baqs that are marketed with a product

being sold and become the property of the purchaser

Certificate ofRegistration No.Name of Dealer

Trading as

Address(Number a;a-il;A or r*at ,"ute)

Kind of business engaged in by dealer

(City, town, or post ofiice) (State) (ZlP Code)

I certify that I am authorized to sign this Certificate of Exemption and that, to the best of my knowledge and belief, it is true andcorrect, made in good faith, pursuant to the Virginia Retail Sales and Use TaxAct.

( Signature) (Tiile)

(lf the dealer is a corporatlon, an officer of the corporation or other person authorized to sign on behaif of the corporation mustsign, if a partnership, one partner rnust sign; if an unincorporated assoctation, a member must sign; if a sole proprietorship, theproprietor must sign.)

lnformation for supplier -A supplier is required to have on file only one Certificate of Exemption properly executed by the dealerwho buys tax exempt tangible personal property for the purpose indicated hereon

Virginra Departmenl of Taxatlon

tREV.10/s9)1462

9V56AF 1.000

By

Page 7: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

B9-00001 2

Rev. 3/05

MassachusettsDepartment ofRevenue

Form ST-4Sales Tax Resale Ceftificate

me of purchaser Social Security or Federal ldenlification number

Address

City/Town State

Type of business in which purchaser is engaged

Type of tangible personal property or service being purchased (be as specific as possibte)

Name of vendor from whom tangible personal propertyor services are being purchased.

GENER-A,L CABLE INDUSTRIES, .tItC . DBA GEPCLT IN.IERNA.j. 1L)I]ALAddress

17 7 C Bi F,CHbIOOD AVENUECity/Town

DES PiAIrr"f,;cSlate zip

IL 6001E

I hereby certify that I hold a valid Massachusetts Vendor's Regjstration, issued by the Commissioner of Revenue, pursuant to Massachusetts GeneralLaws, Chapter 64H, section 7, and that I am in the business of selling the kind of tangible personal property or services being purchased under thiscertificale, and that I intend to sell such property or services in the regular course of my business.

Signed under lhe penalties of perjury.

Signature of purchaser DateTitle

Check applicable box: fl Singte purchase certificate l*-l gtant<et certificate

Notice to VendorsX, Massachusetts General Laws assume that all gross receipts of

. ..="1s66a. from the sale of tangible personal property and services,,:iie from sales subject to tax, unless the contrary is established. Theburden of proving that a sale of tangible personal property or serMceby any vendor is not a retail sale is placed upon the vendor unlesshe/she accepts from the purchaser a certificate declarlng that theproperty or service is purchased for resale.

2. A resale certificate relieves the vendor from the burden of proofonly if it is taken in good failh from a purchaser who is engaged rn

the business of selling tangible property or servlces and who holdsa valid Massachuselts sales tax registration.

3. The good faith of the vendor will be questioned if he/she has

knowledge of facls which give rise to a reasonable\ inference that thepurchaser does not intend to resell lhe property or services. For ex-ample, knowledge thal a purchaser of particular merchandise is notengaged in the business of selling the kind of merchandise or servicehe/she is purchasing under this certlficate would constitute groundsto quest,on the good {aith of the vendor.

4. The vendor must make sure that the certificate is filled out orop.erly and signed before accepting it.

5. The vendor must retain this certifjcate as part of his/her perma-nent tax records.

lf you have any questions about the acceptance or use of this cer-tificate, please conlact: Massachusetts Department of RevenueCustomer Service Bureau, PO Box 7010, Boston, MA 02204, orcall (6 1 7) 8 8 7 -MDOR or toll-free, in-state 1 -900-39t-60A9.

Notice to Purchasers1 . This certifrcate is to be used when the purchaser intends to resellthe tangible personal property or service in the regular course ofbusiness. Manufacturers claiming an exempt use of the malerials,tools and fuel which will be used in the manufacture processing orconversion of tangible personal property should use Form ST-'12,

Exernpt Use Certaflcate. Tax-exempt organizations making purchases for other than resale are to use Form ST-5. Exemot Pur-

chaser Certifica{e.

2. The purchaser must hold a valid Massachusetts vendor regis-tration. lf you need io apply for a registration, go to www.mass.gov/dorand click on WebFile for Business to complete and online applicationfor registration.

3, This certificate musl be signed by and bear the name and ad-dfess of the purchaser and his/her Federal ldentification number.This certificate must also indicate the iype of tangible personalproperty purchased and resold by the purchaser.

4. lf a purchaser who gives a certificate makes any use of the prop-erty other than retention, demonstration or display r,vhile holding it forsale in the regular course of business, such property wili be subjectto the Massachusetts sales or use tax, as of the time lhe property isfirst used by him/her.

5. lf you are engage in a service activity, and are unsure as to theeligibility of the tangtble personal property being purchased for re.sale, see the regulatton on Service Enterprises, 830 CMR 64H.j.1 .

6. For further information about the use of resale certificates,see the regulalion on Resale and exempl Use Certificates, S30CMR 64H,8.1,

.::,:1:!,:'

ztliilrl

Warning: Willful misuse of this certificate may result in criminaltax evaslon sanctions of up to on€ year in prison and 910,000{t50,000 for corporations) in fines.

This form is approved by the commissioner of Revenue and may be reproduced.40M 2tA2 CRPC1029V2421 't OO0

Page 8: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

w

w

w

BLANKET GERTIFICATE OF RESALE

THE UNDERSIGNED CERTIFIES THAT THE FOLLOWING DESCRIBED PROPERW:wire and cable oroducts

PURCHASED FROM: General Cable Indr:stries, f+q. DEA. r3epco Internationalffil]lffif-^.ron.r'o r-" ploir*o. tr, 600lR

AFTER: IS PURCHASED FOR RESALE

OUR MISSISSIPPISALES TAX ID # IS:

Signature Title

BUYER:ADDRESS:

CITY: STATE: ZIP:

Page 9: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

Form ST-105State Form 4965 R,l/ 5-05

Indiana Department of Revenue

General Sales Tax Exemption Certificate

Indlana legistcred rctail rnerchanls aud businesses located outside Indiana may use this cer-tificare. The clairned exemption must be allotved by Indianacode. Exentption statutes of other states are not valid for purchascs fronr Indiana vendors. This exemption certificate can not be issued for thepurchase of Utilities, Vehicles, til'atercraft, or Airtraft. Purchaser must be registered with thc Dcpartment of Revenue or the appropriate taxingauthority of the purchaser's state of residencc.

Sales tar'must be charged unless sll information in each section is fully completed by the purchaser, Purchasers nor able to provide all requiretJinfbrmation rnust pay the tax and rnay file a clairn for rcfund (Fornr CA- t l0L) directly with the Department of Revenue.

[-l ruunr. nf Purcha^rer

t^ll.bl

nus;niss Address -

City Srare _lE I pur.hur.r must provide minimum of one ID numbcr be lorv-x

lEll5l erouicfe your Indiana Registered Retail lv{erchant's Cenificare

I EITID and LOC Number a-s shown on your Certificare.....................

tEl rtD# (t0 disil!)

[$l tf not registered with rhe Indiarra DOR, provide your State Tax

I IID Numbcr fionr another State..................

I | *See instructions on the reverse side if you do not hlve either number, State iD#

zip

LOC# ( 3 digirs)

State of lssue

r;l[ * |

Is this a ! bhnket purchase exemption request or a ft singlc purchase exemption request? lcheck one)tElJf; |

ne"..iption of items to be purchascd.ll

Purchasc-r must indicatc the rype of exenrption being claimed for this purchase. (check one or explain)

Sales to a retailer, who.lesaler, or manufach:rer lbr resale onlv

Sale of manufacturing machinery tools. and equipment to b€ used directly in dircct production.

Sales to nonprufit organizations claiming exempiion pursuant to Sales Tax Infonnation Bulietin #10.(May not be used for personal hotcl rooms and rneals.)

E Sales to persons predominately (517o or more of totirl sales) engaged in public transportation - provicle USDOT#.

tltr

r] Sales to the United States Federal Covernment - show aqency name, _Note: A U.S. Govemment agency should enter its Feder.il Identification Nurnber (FID#) in Section #l in lieu of a State ID#

Other - explain.

I hereby certify under the penalties of perjury that the propnny purchased by rhe use of this exemption certificare is to be used for an exemptpurpose pursuant to the State Cross Retail Sales Tax Act. indiana Code G2._5, and the itern purchased is not a utility, vehicle, watercraft, or aircraft.

I confirm my understanding that misuse, (.tither nelqligent or intentionaD, and.ior tlaudulent use of this certificare may subject both me personallyand./or the business entity I represent to the impositron of tax. interest, and civil anrj/or criminal pcnaltics.

Signature ol Purchaser Date

'l-itlePrinted i

Indiana Department oi Revenue ntay request verification of registration in another state if'you arc an out-ot-state purchaserSeller must keep this certificate on file to suppnrt exempt s:rles.

A pcrson or corporation who is hauling under someone else's motor carier authority. or has a contract as a schcol bus operator, muslprovide their SS# or FID# in lieu of a Srate iD# in Section #1.

Sales to persons, occupationally engaged as fanners, to be us:d directly in production ofagricultural prnducts for sale.Note: A farmer not possessing a Statc Business License# may enrer a FID# or a SS# in lieu of a State ID# in Section #1.

Sales to a contractor for exempt projects (such as public schools, govemment, or nonprofits).

Sales ro Indiana Governmental Units (agencics, cities. towns, municipalities. public schools. and s(ate universities).

The

Page 10: UNIFORM SALES TAX CERTIFICATE-MULTIJURISDICTION · UNIFORM SALES & TTSE TAX CERTIFICATE-MULTIJURISDICTION The below-listed states have indicated that this form ofcertificate is acceptable,

MARYLAND

Suggested Blanket Resale Certificate

This is to certify that all tangible personal property or taxable sewices purchased from:

is intended for resale as tangible personal property or for use or incorporation as a material or part of othertangible personal properly to be produced for sale.

This certificate shall be considered as a part ofeach order which we shall give.

Buyers Name Buvers "Address

2007

Buyer's MD Srler & Use Tar Reglstretion No.