Sales and use tax form in .doc format



State of Michigan requires us to have a current exemption certificate on file. Please return in 20 days to keep your exempt status.

MICHIGAN SALES AND USE TAX CERTIFICATE OF EXEMPTION

This certificate is invalid unless all four sections are completed by the purchaser.

Section 1: Check one of the following

___________One time purchaser ___________Blanket certificate*** ___________ Taxable

The purchaser hereby claims exemption on the purchase of tangible personal property made under this certificate from MOR Electric Heating Assoc., Inc. and certifies that this claim is based upon the purchaser’s proposed use of the items or services, or the status of the purchaser:

Section 2: Items covered by this certificate:

______ All items purchased

______ Limited to the following items: ________________________________________

Section 3: Basis for exemption claim:

________Resale

________At Retail – Sales Tax Registration Number: _________ - __________________

(Example F38-1234567)

________At Wholesale – No Number Required

_______ Agricultural Production: (Describe) ____________________________________________________

_______ Industrial Processing

_______ Non-Profit Organizations

_________Government Entity, Nonprofit School, Nonprofit Hospital, and Church (circle type of organization)

_________Internal Revenue Code Section 501 (c)(3) and 501 (c)(4) Organizations

_________Exempt letter from the State of Michigan

_______Other(explain):____________________________________________________________________

Section 4: Certification:

In the event this claim is disallowed, the purchaser will reimburse the seller for the amount of tax involved.

__________________________________________ ___________________________________________

Purchaser – (Business Name) Street Address

__________________________________________ ___________________________________________

Area Code/Telephone No. City, State, Zip Code

__________________________________________ ___________________________________________

Signature and Title Date Signed

__________________________________________

Name (Print of Type)

*** A blanket certificate is valid for three years from the date of signature unless an earlier expiration date is listed below:

Expiration date, if less than three years: ______________________

We can only accept forms approved by the State of Michigan

as prescribed in Revenue administrative Bulletin 1996-6.

May be faxed to Mor Electric Heating at (616) 784-7775

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