MICHIGAN STATE SALES AND USE TAX

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					                                 MICHIGAN STATE SALES AND USE TAX

                                              EXEMPTION CERTIFICATE


Names of Exempt Organization:                      __________________________________________________

Address:                                           __________________________________________________

                                                   __________________________________________________

Phone #:                                           __________________________________________________


For Consumption:
                                                   Tax Exempt Institution or Agency – Exemption from Federal
                                                   Income Tax as a non-profit organization does not constitute
                                                   exemption from State Sales and Use Tax.

                                                   The undersigned hereby certifies that the item or items being
                                                   purchased is or is to be used or consumed in connection with
                                                   the operation of a:

                                                         School or Church;

                                                         Hospital;

                                                         Home for Aged or Children;

                                                         Government Unit;

                                                         Institutions operated by governmental agencies or other
                                                          entities for educational, benevolent, or charitable
                                                          purposes – copy of Michigan Department of Treasury
                                                          Exemption letter must also be provided.

                                                   It is also certified that the consideration for this purchase moves
                                                   entirely from the funds of the designed institution or agency;
                                                   that no part of the monies used for purchase were paid by
                                                   participants.




Signature and title of person making certification:

____________________________________________________________


Date: ________________________


Michigan State Sales and Use Tax Exempt Cert.doc