Uniform Sales & Use Tax Certificate 3/4 Multijurisdiction
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1Revised 1/12/98, Page 1 of 4
UNIFORM SALES & USE TAX CERTIFICATE MULTIJURISDICTION
The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on pages 2 - 4. The issuer and the
recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change
from time to time.
Issued to Seller: ______________________________________________________________________________________________
Address:
_______________________________________________________________________________________________
I certify that:
is engaged as a registered
Name of Firm (Buyer): ______________________________________________________ Wholesaler
_________________
Retailer
_________________
Address
______________________________________________________ Manufacturer
_________________
Seller (California)
_________________
______________________________________________________ Lessor (see notes
on pages 2 - 4)
_________________
______________________________________________________ Other (Specify)
_________________
and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases
are for wholesale, resale, ingredients or components of a new product or service 1 to be resold, leased, or rented in the normal course of
business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following:
Description of Business: ________________________________________________________________________________________
General description of tangible property or taxable services to be purchased from the seller: __________________________________
___________________________________________________________________________________________________________
State
State Registration, Seller's
State
State Registration, Seller's
Permit, or ID Number of
Permit or ID Number of
Purchaser
Purchaser
2
13
AL
______________________
MO
_____________________
14
AR
______________________
NE
_____________________
3
CA
______________________
NV
_____________________
1
CO
______________________
NJ
_____________________
1,15
4
CT
______________________
NM
_____________________
5
DC
______________________
ND
_____________________
16
6
GA
______________________
OK
_____________________
1,7
17
HI
______________________
RI
_____________________
1
ID
______________________
SC
_____________________
1,8
18
IL
______________________
SD
_____________________
IA
______________________
TN
_____________________
19
KS
______________________
TX
_____________________
9
ME
______________________
UT
_____________________
10
1
MD
______________________
VT
_____________________
11
20
MI
______________________
WA
_____________________
12
21
MN
______________________
WI
_____________________
I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use
Tax we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing.
This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until
canceled by us in writing or revoked by the city or state.
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature:
_____________________________________________________
(Owner, Partner or Corporate Officer)
Title:
_____________________________________________________
Date:
_____________________________________________________
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