Form Cert-110 - Aircraft Repair Services Aircraft Repair And Replacement Parts (Page 2 of 2) in pdf

Form Cert-110 - Aircraft Repair Services Aircraft Repair And Replacement Parts Page 2

Name of Purchaser

Address

CT Tax Registration Number

Federal Employer ID #

(If none, explain.)

(If any)

Name of Seller

Address

CT Tax Registration Number

Federal Employer ID #

(If none, explain.)

(If any)

Check One Box:

Blanket Certificate

Certificate for One Purchase Only

Check Appropriate Box and Provide Written Description of Each Item Purchased

Aircraft Repair Services

Aircraft Repair or Replacement Parts

Description

Declaration by Purchaser

The services or item(s) described above are aircraft repair services or aircraft repair and replacement parts, as described in Conn. Gen. Stat.

§12-412(76) and (77), used exclusively in:

Aircraft; or

The significant overhauling or rebuilding of aircraft or aircraft parts or components on a factory basis.

In accordance with Conn. Gen. Stat. §12-412(76) and (77), 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-110 (Back) (Rev. 07/06)

Form Cert-110 - Aircraft Repair Services Aircraft Repair And Replacement Parts Page 2