Form Sfn 21950 - Re-Sale/tax-Exemption Fax Cover Sheet Page 2

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OFFICE OF STATE TAX COMMISSIONER
CERTIFICATE OF RESALE
SFN 21950 (11-2002)
I hereby certify that I hold _______________ Sales and Use Tax permit number_________________. I am engaged in the business
(State)
of selling, leasing or renting _________________________________________________________________________________.
I further certify that the tangible personal property purchased from ___________________________________________________
is purchased by me for resale.
I further certify that I will report and remit any sales or use tax and any penalties which attach as a result of purchases from
the above seller which are used or consumed by me.
__________________________________________________
__________________________________________________
Business Name
Business Address
__________________________________________________
__________________________________________________
Authorized Signature
Date

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