Transferee Certification For Export Restricted Timber
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Washington State
Department of Revenue
Transferee Certification For
PO Box 47472
Olympia WA 98504-7472
Export Restricted Timber
1-800-548-8829
Transferor’s (Seller) Name
Department of Revenue
UBI Number
Sale Name
600 600 600
jhlkhlkh
Contracting/Selling Agency
Agency Contract Number
lhklkhl
lhl
DNR Region
County
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Forest Practices Application Number
Estimate of Volume Transferred
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List:
Species
Volume
Unit of Measure
;lk;l
k;lk
;lk
;l
;lk
;k
;klk
kjh
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kjh
kjh
kjh
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Assigned Log Brand Description
Registered Log Brand Number
Representative’s Signature
The Transferee hereby affirms, under penalty of law, the truth of the following:
A. Transferee (Buyer) will not export unprocessed timber purchased under said application.
B. Transferee will not transfer said timber to any other person or corporation for the purpose of either export or
substitution.
C. That hammer brands and red paint applied to such timber as required by WAC 240-15-025 shall remain until it is
domestically processed.
D. That prior to selling, trading, exchanging, or otherwise conveying export restricted timber to any other person, the
transferor (seller) shall require the transferee to sign a completed Transferee Certification. The original is to be mailed
to the Department of Revenue prior to the logs being physically transferred.
Making false statements on the Bidder Certification is punishable as a gross misdemeanor RCW 9A.72.040.
Transferee’s (Buyer) Name
UBI Number
kjhkjh
Address
Phone Number
kjh
City, State, Zip Code
Fax Number
k;lk
Representative’s Name
Representative’s Title
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k;lk
Representative’s Signature
Date
Delivery Point
REV 62 0076e (3/6/12)
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