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TAX EXEMPTION FORM 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 ___________________
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