CT TAX RESALE CERTIFICATE

Issued to (Seller)

Address

Name of Firm (Buyer)

AddressSALES & USE TAX RESALE CERTIFICATE

Name of Firm (Buyer)

Wholesaler Retailer Manufacturer Lessor Other specifyis engaged as a registeredWholesaler Retailer Manufacturer Lessor Other specify

Street Address or P.O. Box No.

City

State

Zip

and is registered with the below listed states and cities within which your firm would deliver pur- chases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product to be resold, leased, or rented in the normal course of our business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following

or I.D. No.

Or I.D. No.

or I.D. No.

I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a sales or use tax we will pay the tax due direct to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state.

General description of products to be purchased from the seller

I declare under the penalties of false statement that this certificate has been examined by me and to the best of my knowledge and belief is a true, correct and complete certificate.

(Owner, Partner or Corporate Officer)

CT SALES & USE TAX RESALE CERTIFICATE