Uniform Sales & Use Tax Exemption/resale Certificate - Multijurisdiction

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UNIFORM SALES & USE TAX EXEMPTION/RESALE CERTIFICATE — MULTIJURISDICTION
The below-listed states have indicated that this certificate is acceptable as a resale/exemption certificate for sales and use tax, subject to the notes on
pages 2─4. The issuer and the recipient have the responsibility to determine the proper use of this certificate under applicable laws in each state, as
these may change from time to time.
Issued to Seller:
Address:
I certify that:
is engaged as a registered
 Wholesaler
Name of Firm (Buyer):
 Retailer
Address:
 Manufacturer
 Seller (California)
 Lessor (see notes on pages 2─4
)
 Other (Specify)
_________________
and is registered with the below-listed states and cities within which your firm would deliver purchases to us and that any such purchases are for
1
wholesale, resale, or ingredients or components of a new product or service
to be resold, leased, or rented in the normal course of business. We are
in the business of wholesaling, retailing, manufacturing, leasing (renting) selling (California) the following:
Description of Business:
General description of tangible property or taxable services to be purchased from the Seller:
State
State Registration, Seller’s Permit, or ID
State
State Registration, Seller’s Permit, or ID
Number of Purchaser
Number of Purchaser
1
16
AL
MO
17
AR
NE
2
AZ
NV
3
CA
NJ
4
4,18
CO
NM
5
19
CT
NC
6
DC
ND
7
20
FL
OH
8
21
GA
OK
4,9
22
HI
PA
23
ID
RI
4,10
IL
SC
24
IA
SD
KS
TN
11
25
KY
TX
12
ME
UT
13
MD
VT
14
26
MI
WA
15
27
MN
WI
I further certify that if any property or service so purchased tax free is used or consumed as to make it subject to a Sales or Use Tax we will pay the
tax due directly to the proper taxing authority when state law so provides or inform the Seller for added tax billing. This certificate shall be a part of
each order that we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the e city or
state.
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature:
(Owner, Partner, or Corporate Officer, or other authorized signer)
Title:
Date:
1
Revised 5/18/2016

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