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TAX STATUS CERTIFICATE

MICHIGAN SALES & USE TAX

 

The undersigned purchaser, being fully informed concerning the Michigan Sales & Use Tax Acts and their Rules & Regulations, hereby certifies he/she is entitled to Exemption from such taxes, reason for one or more of the following classifications:

 

( ) EXEMPT, as Materials are PURCHASED FOR RESALE

 

( ) EXEMPT, as Materials are USED IN PRODUCTION and/or     INDUSTRIAL PROCESSING

 

( ) EXEMPT, as Materials are USED BY NON-PROFIT ORGANIZATION

 

( ) EXEMPT, as Materials Sales and/or Use Tax will be paid by us, direct to the state, based on actual usage

 

( ) EXEMPT, as Materials are used for other reasons specified:______________________________________

 

 

The undersigned hereby makes this certificate a part of each purchase unless otherwise specified on such order, and agrees to reimburse the Seller for any deficiencies imposed by the State of Michigan for Violations of such Rules and Regulations.

 

This certificate shall remain in effect for the period for which the State of Michigan shall hold the seller liable.

 

                FIRM NAME_________________________________________________________________

 

                STREET_____________________________________________________________________

 

                CITY________________________________ STATE____________ ZIP_________________

 

                PHONE______________________________  FAX___________________________________

 

                TYPE OF BUSINESS___________________________________________________________

 

                SALES TAX LICENSE NUMBER________________________________________________

 

                AUTHORIZED SIGNATURES __________________________________________________

 

                TITLE________________________________________  DATE _________________________