Form Pr-78ssta - Streamlined Sales Tax Agreement - Certificate Of Exemption - 2005
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1
2Streamlined Sales Tax Agreement
Certificate of Exemption
Warning to purchaser:
This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for
knowing if they qualify to claim exemption from tax in the state that is due tax on this sale.
Sellers may not
accept a certificate of exemption for sales sourced within the state if an exemption does not apply in the seller’s
state.
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State of Issue
Number
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Type of Business.
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______________________________
(explain)
Reason for Exemption.
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_____________
(department)
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______________
(name)
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____________________
(name)
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______________________________
(explain)
I declare that the information on this certificate is correct and complete to the best of my knowledge and belief.
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