STATE OF ____________ , USA
CERTIFICATE OF EXEMPTION
The undersigned hereby claims exemption from sales tax for purchases of tangible personal property from
RG PEARL TUTU & COSTUME CARE
On and after ___________________ and certifies that this claim is based upon the
(Date)
Purchaser’s proposed use of the items purchased and/or the activity of the Purchaser
as shown below. This certificate shall continue in force until revoked and shall be considered a part of each purchase.
PURCHASER INFORMATION (Print or Type Clearly)
Tax Exempt Number ____________________________________
(Vendor License No., Federal ID No.)
Name/Organization _______________________________________
Physical Address _______________________________________
(Street Number and Name, Suite or Apt. Number)
________________________________________
(City, State Zipcode)
Telephone Number ___________- ___________- ________________
(Area Code)
Purchaser Activity (Check the Appropriate Box)
Purchased for resale Other –
Not-for-Profit Organization
Authorized Representative ________________________________________
(Signature)
_____________________________________________
(Position or Title)
______________________________________________
(Date of Signature)
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