Final Sales Tax Affidavit (Page 2 of 10) in pdf

Final Sales Tax Affidavit Page 2

FINAL SALES TAX AFFIDAVIT

Project Name:

Project Location:

Sales Tax Period:_______________________________________________________

Gross Amount Paid For Materials: _________________________________________

Amount of Sales Tax Paid On Materials:_____________________________________

Local Jurisdiction In Which the Sales Tax Was Remitted:______________ Amount______________

County In Which The Sales Tax Was Remitted:________________

Amount______________

State In Which The Sales Tax Was Remitted: __________________

Amount_____________

Printed Name: __________________________________________________________

Company Name: ________________________________________________________

Date: _________________________________________________________________

Authorized Signature:____________________________________________________

The purpose of this affidavit is to provide us documentation that you have paid sales tax on materials purchased for Summit Contractors

Group, Inc. for the project referenced above. This document must be signed, notarized and returned to our office with PROOF OF

PAYMENT OF ALL APPLICABLE TAXES prior to the release of your final/retainage check. The execution of this document is

verification that the above listed company has remitted sales tax to the appropriate jurisdictions for the above referenced project.

PLEASE NOTE: THIS EXECUTED DOCUMENT AND PROOF OF PAYMENT IS REQUIRED BEFORE RELEASE OF YOUR

FINAL/RETAINAGE CHECK. NO EXCEPTIONS.

STATE OF __________________

COUNTY OF ________________

The

foregoing

instrument

was

acknowledge

before

this___________

day

______________,

20__,

by______________________________, who is personally known to me or who has produced _____________________________ as

identification.

NOTARY PUBLIC:___________________________________

Typed Name:_________________________________________

Commission Expires:___________________________________

Commission No:_______________________________________

Final Sales Tax Affidavit Page 2