Form E-595ea - Application For Commercial Fisherman, Commercial Logger, And Veterinarian Exemption Certificate Number For Qualified Purchases - 2014

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4
E-595EA
Application for Commercial Fisherman,
PRINT
CLEAR
Web-Fill
Commercial Logger, and Veterinarian Exemption
6-14
Certificate Number for Qualified Purchases
Office Use
North Carolina Department of Revenue
1.
If Corporation, Partnership, or LLC
If Proprietorship enter
Social Security Number:
Federal Employer ID No.:
enter
2.
Type of Ownership:
Proprietorship
Corporation
Partnership
LLC
Other (Identify)
3.
Applicant’s Legal Name:
4.
Trade Name (DBA Name):
5.
Street Address:
Street
(Not P.O. Box Number)
City
State
Zip Code
6.
Mailing Address:
Street or P.O. Box
City
State
Zip Code
7.
Type of Business or Profession:
Commercial Fisherman
Commercial Logger
Veterinarian
8.
Dollar amount of annual income from business or professional activities:
Check if started within the year.
Check if moved to North Carolina within the year.
9.
Describe the type of items sold and/or produced or services rendered:
Signature:
Date:
I certify that this application is accurate and complete.
Name (Print):
Title:
E-mail:
Phone:
Mail to: N.C. Department of Revenue, Registration Unit
P. O. Box 25000, Raleigh, NC 27640-0001

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