Form Cert-128 - Exempt Purchases By Contractors In Connection With Construction Projects In Indian Country Of The Mashantucket Pequot Or Mohegan Tribes Page 2
ADVERTISEMENT
1
2Name of Seller
Address
CT Tax Registration Number
Federal Employer ID #
(If none, explain)
Name of Purchaser
Address
CT Tax Registration Number
Federal Employer ID #
(If none, explain)
Check One Box
Blanket Certificate
Certificate for One Purchase Only
Check One Box
Purchased
Rented
Description
Declaration by Purchaser
I declare that:
•
The purchaser is a construction contractor purchasing or renting tangible personal property for use in connection with a construction
contract with the Mashantucket Pequot Tribe or the Mohegan Tribe or an enrolled member of the tribe performed in the Indian country
of the tribe;
•
Title to the property or delivery of rented property will be taken in Indian country of the tribe (unless a Buy Connecticut permit is
provided);
•
The property will be used exclusively and permanently (in the case of rented property, for the entire rental period) by the contractor in
Indian country of the tribe; and
•
The entire cost of the property or entire cost of the rental of the property during the rental term will be passed on to the tribe or an enrolled
member of the tribe.
I acknowledge that the contractor will be liable for Connecticut use tax, plus penalty and interest, on the total purchase price of the property
if the contractor does not meet the conditions listed above.
I declare under penalty of law that I have examined this document (including any accompanying schedules and statements) and, to the best
of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document
to DRS is a fine of not more than $5,000, or imprisonment for not more than five years, or both.
Name of Tribe or Enrolled Member
Location of Construction Project
By:
Signature of Purchaser
Title
Date
CERT-128 (Back)
(Rev. 01/05)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cert-127 - Exempt Purchases By An Enrolled Member Or By The Tribal Government Of The Mashantucket Pequot Tribe Or Mohegan Tribe
Financial
Form Cert-128 - Certificate For Exempt Purchases By Contractors In Connection With Construction Projects On The Mashantucket Pequot Or Mohegan Reservations - 1996
Financial
Form Cert-128 - Certificate For Exempt Purchases By Contractors In Connection With Construction Projects On The Mashantucket Pequot Or Mohegan Reservations
Legal
Form Cert-128 - Certificate For Exempt Purchases By Contractors In Connection With Construction Projects On The Mashantucket Pequot Or Mohegan Reservations
Financial
Form Cert-128 - Certificate For Exempt Purchases By Contractors In Connection With Construction Projects On The Mashantucket Peqot Or Mohegan Reservation
Financial
Form Cert-127 - Certificate For Exempt Purchases By An Enrolled Member Or By The Tribal Government Of The Mashantucket Pequot Tribe Or Mohegan Tribe
Legal
Related Categories
Parent category: Financial