(Check applicable boxes)
Wholesale, resale or ingredient/component parts of a new
product to be resold
Charitable or religious organization
Educational institution
Political subdivision or government agency
other (please specify)
description of purchase:
Further, the undersigned certifies that if any property so purchased tax free is used or consumed as to make
it subject to tax, that the above named purchaser assumes liability for payment of the tax direct to the proper
taxing authority when the law so provides. This certificate shall be considered a part of each order which hereafter
may be given to the above named seller, and shall be valid until revoked by the purchaser.
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