Federal Excise Tax On Archery Equipment Exemption Certificate printable pdf download

Federal Excise Tax On Archery Equipment Exemption Certificate

Federal Excise Tax on Archery Equipment

EXEMPTION CERTIFICATE

For use by states, local governments and public schools

Section 4221(a)(4) of the Internal Revenue Code

________________________________, 20____

Date

I hereby certify that I am ___________________________________________________

(Title of Officer)

of_____________________________________________________________________,

(State, local government or school)

(Employer Identification Number)

that I am authorized to execute this certificate;

and that all orders placed by our school or government agency

for the period commencing _______________ and ending _______________

(period not to exceed 3 years),

are purchased from Brennan Industries, Inc. for the exclusive use of

_____________________________of __________________________.

(Government agency or public school)

(State or local government)

I understand that the exemption from tax in the case of sales of articles under this exemption

certificate to a government agency or public school is limited to the sale of articles purchased for

exclusive use by the government agency or school.

I understand that the fraudulent use of this certificate for the purpose of securing this exemption

will subject me and all parties making such fraudulent use of this certificate to a fine of not more

than $10,000, or to imprisonment for not more than five years, or both, together with costs of

prosecution.

_____________________________________________________

Signature of Authorized Individual

_____________________________________________________

Title

_____________________________________________________

Address

Please return by mail or fax to:

Brennan Industries, the makers of the Genesis bow

2035 Riley Road

Sparta, WI 54656

Phone (608) 269-1779

Fax (608) 269-0172

Federal Excise Tax On Archery Equipment Exemption Certificate