Fillable Form St-11a - Sales And Use Tax Certificate Of Exemption (Page 2 of 2) in pdf

Form St-11a - Sales And Use Tax Certificate Of Exemption Page 2

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Form ST-11A

Page 2

Name of Purchaser

Trading Date

Address

Number and Street, or Rural Route

City, Town, or Post Office

State

ZIP

I certify that I am authorized to sign this Certificate of Exemption and that, to the best of my knowledge and belief, it is true and correct, made in good faith,

pursuant to the Code of Virginia.

By (Signature)

Title

If the purchaser is a corporation, an officer of the corporation or other person authorized to sign on behalf of the corporation must sign; if a partnership, one

partner must sign; if an unincorporated association, a member must sign; if a sole proprietorship, the proprietor must sign.

1. Information to Purchaser: This certificate of exemption can only be used to purchase tax exempt tangible personal property for this particular project,

and it cannot be used after the completion date of this particular project.

2. Information to Supplier: A supplier is required to have on file for each project only one certificate of exemption properly executed by each purchaser

buying tax exempt tangible personal property for the purpose indicated thereon.

Va. Dept. Of Taxation 6201058 ST-11A REV 5/10