Federal Tax Exempt Forms by gjl53109


Federal Tax Exempt Forms document sample

More Info
									                                            CERTIFICATE OF EXEMPTION FROM

Name of business/institution/organization claiming exemption (Customer)                                                              Customer’s federal identification number

Customer’s address, city, state and ZIP code

Customer’s exempt from Frontier a Citizens Communications Co. account number(s): -------------------------------------------------------------------------------------------

To be valid, all information provided must be LEGIBLE. Any certificate with missing information will be returned. Exemption status can
only be considered with a completed certificate. Any modification made to the printed text of the certificate render it null and void.

1. The undersigned hereby certifies that he/she is authorized to execute this certificate on behalf of Customer and that the exemption claimed is
allowable. Under the penalties of perjury, the undersigned swears or affirms that the information on this certificate is true and correct as to every
material matter. This certificate shall be valid until canceled by Frontier a Citizens Communications Co. or Customer in writing or revoked by any
authority or jurisdiction.

2. If any exemption claimed on this certificate is disallowed, Customer agrees to indemnify Frontier a Citizens Communications Co. for any and all
taxes, fees, surcharges, or other charges, interest and penalties, including all legal and collection fees or any other costs that may be assessed against
Frontier a Citizens Communications Co. or Customer by any authority or jurisdiction for which this exemption has been claimed by Customer.

Signature of authorized Customer representative                 Printed name of authorized Customer representative, Title                                           Date signed

____________________________________________________________________                                          _______________________ to December 31, ________
Customer’s representative telephone number                   Customer’s representative fax number             Effective period (read “Effective period” below)

Effective period. In accordance with Reg. 49.4253-11 this blanket certificate can be valid for a period not to exceed one year. The initial
certificate is valid until December 31st of the initial effective period. The Tax Department at Frontier a Citizens Communications Co. will mail a
renewal certificate during the expiration month of December. The new certificate is valid from January 1 st to December 31st for the next calendar
year. This method will help ensure compliance with applicable laws. The initial effective period date should be on or before first purchase/order.

Contact. Contact Mary Kalata at (203) 614-4606 with any questions. This certificate with the original signature must be mailed to Mary Kalata,
Frontier a Citizens Communications, Tax Dept., 3 High Ridge Park, Stamford, CT 06905. To expedite your request fax Mary at (203) 614-4663.

Check the appropriate provision section (you can only check one) and provide any additional information where required.

The Customer certifies the communication services furnished by Frontier a Citizens Communications Co. It will be used exclusively in the rendering
of a communication service upon which tax is imposed by IRC section 4251. The Customer understands that no tax will be collected by Frontier a
Citizens Communications Co. and the Customer will be responsible to collect any tax as may be legally due from Customers members/customers and
to remit it to the required authority. The Customer also understands that if Customer uses or consumes any exempted communication service, the
Customer will report and remit any tax due to the required authority.

The Customer understands that in accordance with P.L. 101-508 amending IRC section 4253(k) when the basis for tax exemption as indicated on the
original certificate changes or ceases to exist as to make Customer subject to the exempted tax, the Customer agrees to notify Frontier a Citizens
Communications Co. in writing within 30 days by (1) completing a new certificate, (2) checking this provision and (3) resubmit the new certificate to
Frontier a Citizens Communications Co., Tax Department.

Effective change date: ________________________ for Frontier a Citizens Communications Co account number(s): ________________________

Describe change and product(s) effected (when required): ________________________________________________________________________

Last revised: August 2, 2002                                                     1 of 1           311737e1-be7b-4ea0-b846-df7e3a4be79e.doc

To top