Form Rev 27 0020 - Resale Certificate
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1Washington State
Department of Revenue
RESALE CERTIFICATE
1. Name of Seller __________________________________________________________________________
2. Name of Buyer/Business __________________________________________________________________
3. Address of Buyer ________________________________________________________________________
Street
City, State
Zip
4. Buyer’s UBI/Revenue Registration Number __________________________________________________
5. Buyer is in the business of ________________________________________________________________
6. Types of items purchased for resale _________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
The buyer certifies that it is purchasing the items listed on line 6 (please check
appropriate box):
¨
for resale in the regular course of business without intervening use.
¨
for use as an ingredient or component part of a new article of tangible
personal property to be produced for sale,
¨
as a chemical to be used in processing a new article of tangible personal
property to be produced for sale, or
¨
for use as feed, seed, seedlings, fertilizer, or spray materials in its capacity
as a farmer.
The buyer acknowledges that it is solely responsible for purchasing within the
categories listed on line 6. The buyer acknowledges that misuse of the resale
privilege subjects the buyer to a penalty of 50 percent of the tax due, in addition
to the tax, interest, and any other penalties imposed by law.
Print Name_______________________________________________________________________________
Name of Person Authorized By the Buyer to Sign the Resale Certificate
Signature_________________________________________________________________________________
Signature of Authorized Agent of the Buyer
Effective Date ______________________________through________________________________________
(Not To Exceed 4 Years)
Date Signed ________________________
Seller must maintain a copy. Please do not send to Department of Revenue.
Reference Rule and Statue (RCW 82.08.130 and WAC 408.20.102)
REV 27 0020 (12-18-96)
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Parent category: Financial