Form Application For Chapter 100 Sales Tax Exemption Personal Property Page 3

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County (if the County is the bond issuer)
Print Name
Title
Signature
Date
Notary Public Embosser Seal
Appeared before me this _________ day of _______________, 20____,
____________________________ to me personally known to be the person who executed the above
certification, and acknowledged and states on his/her oath to me that he/she executed the same for the
purpose therein stated.
State of
County (or City of St. Louis)
Notary Public Name
My Commission Expires
Use Rubber Stamp in Area Below
Notary Public Signature
Business
Print Name
Title
Signature
Date
Notary Public Embosser Seal
Appeared before me this _________ day of _______________, 20____,
____________________________ to me personally known to be the person who executed the above
certification, and acknowledged and states on his/her oath to me that he/she executed the same for the
purpose therein stated.
State of
County (or City of St. Louis)
Notary Public Name
My Commission Expires
Use Rubber Stamp in Area Below
Notary Public Signature

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