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CERTIFICATE OF EXCEMPTION
Purchaser holds a valid registration or permit number_____________________, issued under the Retail Sales
and / or Use Tax Act of the State of:______________________________
I certify that the tangible personal property purchased from discountshoppingbags.com on each order we shall
give, unless such order shall otherwise specify and until this notice is revoked by us in writing, is purchased
for the following indicated use:
_____ Resale without change in form.
_____ To be incorporated as a material or component part of the other tangible personal property to be
produced by the undersigned by manufacturing, process, fabrication, assembling or refining and to be
subsequently resold to others.
_____ Tax
will be paid directly to the State, County, and City under direct pay permit
number:
____________________
_____
Exempt organization
_____ Other (describe) _______________________________________________________
I further certify that I assume liability for payment of the tax, penalties and interest imposed by law if the
property purchased is used or consumed in such a manner as to render such use subject to tax.
DATED:
______________ PURCHASER:
________________________________________
(Company Name)
ADDRESS: __________________________________________________________________
(Number and Street)
__________________________________________________________________
(City and State)
BY: __________________________________________________________________
(Signature) (Title)
(Regulations provide that certificates must be dated, and registration number, address,
and signature in to be effective) Thank you.