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THIS FORM IS TO BE
FORM
MISSOURI DEPARTMENT OF REVENUE
149
GIVEN TO THE SELLER BY
TAXATION BUREAU
THE PURCHASER.
(REV. 9-2006)
SALES/USE TAX EXEMPTION CERTIFICATE
PART A
1. PURCHASER
DOING BUSINESS AS
ADDRESS
CITY, STATE, AND ZIP
2. SELLER
DOING BUSINESS AS
Static Control Components, Inc.
ADDRESS
CITY, STATE, AND ZIP
3010 Lee Avenue
Sanford, NC 27332
3. PRODUCT OR SERVICES PURCHASED
4. PURCHASER’S TYPE OF BUSINESS
5. CLAIMING EXEMPTION FROM SALES/USE TAX FOR:
RESALE (COMPLETE PART B BELOW)
MATERIAL RECOVERY PROCESSING
MANUFACTURING MACHINERY, EQUIPMENT AND PARTS
WHOLESALERS (TAX ID NOT REQUIRED)
INGREDIENT / COMPONENT PART
COMMON CARRIER
AGRICULTURAL
LOCOMOTIVE FUEL
OTHER (EXPLAIN)
MOTOR VEHICLE DEALER (Provide Dealer Registration Number)
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
6. CLAIMING EXEMPTION FROM TIRE FEE FOR:
RESALE — REGISTERED TIRE RETAILER
MISSOURI TIRE FEE ID NUMBER
FAMILY FARM / FAMILY FARM CORPORATION
7. CLAIMING EXEMPTION FROM LEAD-ACID BATTERY FEE FOR:
RESALE — REGISTERED BATTERY RETAILER
MISSOURI BATTERY FEE ID NUMBER
AGRICULTURAL OPERATIONS
PART B
IF CLAIMING EXEMPTION FOR RESALE, PLEASE COMPLETE THE FOLLOWING
1. PURCHASER’S HOME STATE
2. PURCHASER’S STATE TAX I.D. NUMBER (or Dealer Registration Number for exemption
from sales/use tax only, if applicable)
3. GENERAL DESCRIPTION OF PRODUCT TO BE PURCHASED FROM THE SELLER ______________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________
Note: Illinois does not have an exemption on sales of property for subsequent lease or rental.
Caution to Seller: In order for the certificate to be accepted in good faith by the seller, the seller must exercise care that the property being sold is of a type
normally sold wholesale, resold, leased, rented, or utilized as an ingredient or component part of a product manufactured by the buyer in the usual course of
business. In some states or cities, a seller failing to exercise due care could be held liable for the sales tax due.
PART C
I SWEAR OR AFFIRM THE INFORMATION ON THIS FORM IS TRUE AND CORRECT AS TO EVERY MATERIAL MATTER.
AUTHORIZED SIGNATURE (PURCHASER OR PURCHASER’S AGENT)
DATE
MO 860-1528 (9-2006)