Form St-111 - Sales Tax Exemption Claim Form - Grocer

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Grocer must have a sales tax resale or exemption
ST-111 SALES TAX EXEMPTION CLAIM FORM - GROCER
certificate on file from the customer for this claim
to be valid.
GROCER - Complete this portion.
CUSTOMER - Complete this portion.
Check One
Nontaxed
Date
Business Name
Seller's Permit - Resale Only
Sign Your Name
or Both
Amount
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
Food
$
-
Nonfood
EFO00221
10-30-1996

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