Form 604-A - Non-Taxable Transaction Certificate Application
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-A
HE
AVAJO
ATION
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FFICE
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AVAJO
AX
OMMISSION
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ON-
AXABLE
RANSACTION
ERTIFICATE
PPLICATION
Name of Business or Organization
:
Mailing Address :
TIN/SSN:
Telephone No.:
Fax No.:
Give location, contract number, and brief description of project for which certificates are being requested:
Total contract price of project:
$
Indicate below subcontractors (including materialmen) to whom certificates will be issued:
1
.
11
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2
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12
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15
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x
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Contractor Signature
Print or Type Name
Date
**RETURN COMPLETED APPLICATION TO THE OFFICE OF THE NAVAJO TAX COMMISSION**
FOR OFFICE USE ONLY
Certificate Number
through
.
Date Issued:
Approved By:
Office of the Navajo Tax Commission
Post Office Box 1903, Window Rock, AZ 86515
604A
Ph: (928) 871-6681 Fax: (928) 871-7608
Revised: 10/3/2002
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