Excise Tax Exemption Certificate (Page 2 of 2) in pdf

Excise Tax Exemption Certificate Page 2

CERTIFICATE OF ULTIMATE PURCHASER

(Date) ______________/_____________, 20 _____.

I, hereby certify that I am _________________________________________________________ of the

(Title of the authorized purchaser: Please print name)

__________________________________________ and That I am authorized to execute this certificate:

(State or local government)

And that the article or articles specified in the Accompanying order are, or will be, purchased from

Botach Tactical 3423 West 43rd Place, Los Angeles, CA 90008

for the exclusive use of _______________________________________________________________________.

(Agency ordering the weapons Ultimate purchaser)

of the ______________________________________________________________________________________.

(State or local government in Charge of the ordering agency).

The undersigned understands that the fraudulent use of this statement may subject the Undersigned or any

other party. Making such fraudulent use to all applicable criminal penalties under The Internal Revenue Code.

The undersigned agrees to notify the man Manufacturer/importer it the article is not in fact used as Specified in

the certificate. The following weapons will be used for Law Enforcement use only.

__________________________________________________________________________________.

(Description Of Weapons ordered and Quantity )

Signature:

______________________________________________________________________

Address:

______________________________________________________________________

City:

__________________________

State: ______________

Zip: _________

Phone:

________ / _______ - __________

Fax: ________ / _______ - ________

Please mail original To:

BOTACH TACTICAL 3423 West 43

Place, Los Angeles, CA 90008

PH: 323/294-5555 Fax:323/294-3542

Excise Tax Exemption Certificate Page 2