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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