Form Cert-120 - Certificate For Machinery, Equipment, Tools, Materials, And Supplies Used In The Production Of Printed Material Or In Prepress Production Page 2

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DECLARATION BY PURCHASER

The item(s) described above are machinery, equipment, tools, materials or supplies to be used predominantly in (a) the production of printed material by a

commercial printer or publisher, as described in Conn. Gen. Stat. §12-412(71), or (b) the prepress production of products to be sold for use in the production

of printed material, as described in Conn. Gen. Stat. §12-412(72).

In accordance with Conn. Gen. Stat. §12-412(71) and (72), the purchase of the above-described item(s) is exempt from sales and use taxes.

I hereby declare, under the penalties of false statement, that I have personal knowledge about the information contained herein and that to the best of my

knowledge and belief it is true, complete and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two

thousand dollars.)

Name of Purchaser

By: __________________________________ _________________________ ________________

Authorized Signature

Title

Date

CERT-120 (BACK) (Rev. 11/97)