Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry (Page 2 of 2) in pdf

Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry Page 2

Name of Purchaser

Address

CT Tax Registration Number

Federal Employer ID #

(If none, explain)

Name of Seller

Address

CT Tax Registration Number

Federal Employer ID #

(If none, explain)

Check One Box

Blanket Certificate

Certificate for One Purchase Only

Check Appropriate Box and Provide Written Description of Each Item Purchased

Machinery

Equipment

Tools

Materials

Supplies

Fuel

Description

Declaration by Purchaser

The item(s) described on the front are machinery, equipment, tools, materials, supplies, or fuel as defined in Conn. Agencies Regs.

§12-412(89).

In accordance with Conn. Agencies Regs. §12-412(89), the purchase of these item(s) is exempt from sales and use taxes.

Declaration: I declare under penalty of law that I have examined this return or 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 Purchasing Company

By:

Authorized Signature of Owner or Officer

Title

Date

CERT-129 (Back)

(Rev. 01/05)

Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry Page 2