Purchaser Certification For Export Restricted Timber
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1
2State of Washington
Purchaser Certification For
Department of Revenue
PO Box 47472
Export Restricted Timber
Olympia WA 98504-47472
Reset This Form
1-800-548-8829
Contracting/Selling Agency:
Sale Name:
Date of Sale:
Agency Contract Number:
DNR Region:
County:
Forest Practices Application Number:
Legal Description: Sec/Twp/Rge:
Estimated Sale Volume:
Unit of Measure: MBF Scribner, Weight (pounds, tons), Cords, Other
Assigned Log Brand Description:
Registered Log Brand Number:
The Purchaser hereby affirms, under penalty of law, the truth of the following:
A. That export restricted unprocessed timber will not be:
Exported by the Purchaser or used in substitution by the Purchaser, or
Transferred to any other person for the purpose of export or substitution.
B. That hammer brands and red paint applied to such timber as required by WAC 240-15-025 shall remain
on such timber until it is domestically processed.
C. That prior to selling, trading, exchanging, or otherwise conveying export restricted timber to any other
person, the purchaser (transferor) shall require the transferee to sign a completed Transferee
Certification. The original is to be mailed to Department of Revenue prior to the logs being physically
transferred.
D. That the transferor shall not sell, trade, exchange or otherwise convey export restricted timber to any
other person on the Department of Revenue ineligible list.
Making false statements on the Bidder Certification is punishable as a gross misdemeanor
RCW 9A.72.040.
Purchaser’s Name:
Address:
City, State, Zip Code:
Phone Number:
FAX Number:
UBI Number:
Timber Tax Number:
Representative’s Name/Title:
Representative’s Signature:
Date:
1
REV 62 0077e (w) (3/2/07)
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