Fillable Form St-12a - Waiver Of Vendor'S Rights For Refund printable pdf download

Form St-12a - Waiver Of Vendor'S Rights For Refund

Download a blank fillable Form St-12a - Waiver Of Vendor'S Rights For Refund in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form St-12a - Waiver Of Vendor'S Rights For Refund with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

CLEAR

ST-12A

(Rev. 7/14)

MAIL TO:

Georgia Department of Revenue

1800 Century Boulevard, NE Ste 8214

Atlanta, GA 30345-3205

Telephone No. 1-877-423-6711

WAIVER OF VENDOR’S RIGHTS FOR REFUND

Name of Purchaser

Purchaser’s Certificate Number

Name of Vendor

Vendor’s Certificate Number

Vendor’s Street Address, City or Town, State and Zip Code

Gross Amount

Exempt

Tax Paid

Date

Invoice No.

of Sale

Portion, if any,

To Vendor

Item Sold

Excluding Tax

of Sale

By Purchaser

MM/DD/YY

AFFIDAVIT OF VENDOR

The undersigned authorized representative of the above-named vendor does hereby certify under oath that the above figures are true and correct with

respect to its transactions with the above-named purchaser for the periods indicated, that the sales tax shown paid was collected from this purchaser

and was remitted to the Department of Revenue, and that this vendor disclaims any interest in said sales taxes remitted to the Department of Revenue

and waives any right to refunds due therefor.

This day of _________________,______.

______________________________________________

Vendor

By: ___________________________________________

Name and Title

Subscribed and sworn to:

This ____ day of ____________,______.

_____________________________________

Notary Public

THIS WAIVER SHALL BE ATTACHED TO AND MADE A PART OF SALES TAX CLAIM OF PURCHASER

Form St-12a - Waiver Of Vendor'S Rights For Refund

Related Articles

Related forms

Related Categories