RESALE CLARIFICATION FORM
FOR
DENVER SALES TAX
Purchaser Representation
:
Company Name ____________________________________________________________________________________
Address___________________________________________________________________________________________
City/State/Zip ______________________________________________________________________________________
Representative _______________________________Title __________________________________________________
If no Denver ID;
Denver Tax ID: _____________________________
___________________________________________
State Tax ID:
Specific item(s) to be purchased for resale________________________________________________________________
True
False
The organization named above is licensed to collect and remit sales taxes
to the State of Colorado and, if necessary, the City and County of Denver.
The items mentioned above will actually be resold in the normal course
of business and are not for the use of the organization named above.
I agree to reimburse the vendor for Denver taxes associated with this transaction
if the City and County of Denver disallows the exemption upon audit or review.
All of the above must be true for the purchase to qualify for exemption.
This form may be provided to the City & County of Denver.
The undersigned declares and affirms that the above statements are true and the above named company acknowledges its liability to
the vendor for the tax in the event the transaction does not qualify for exemption. (Attach a copy of the signer’s driver’s license or
other appropriate form of photo identification)
Name ______________________________________________ Title _________________________ Date __________
Vendor Representation:
Important: Use of this form does not relieve the vendor of its obligation to verify that all conditions for exemption
have been met. All exempt transactions are subject to audit, and the vendor may be held responsible for payment
of taxes related to transactions exempted in error.
By signing below, I certify that I have sufficient knowledge of this purchaser’s business to believe the items described above will be
resold and are not for the purchaser’s own use.
By:
___________________________________________________________________________________________
Printed Name: _______________________________________ Title: ________________________________________
The City and County of Denver recommends retaining this document for at least four years subsequent to the transaction date.
Issue 12/02