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Blanket Certificate of Exemption Kansas - PDF

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					                                                                    BLANKET CERTIFICATE OF EXEMPTION
                                   The undersigned hereby claims exemption to purchases of tangible personal property from Ponica
                                   NDUSTRIES CORP. and certifies that this claim is based upon the purchaser's proposed use of the
                                   items purchased, the activity of the purchaser, or both, as shown hereon:

                                      FOR RESALE IN THE FORM WHICH THE SAME IS, OR IS TO BE RECEIVED
                       This certificate applies to all of the below indicated states for which shipments are made to for the firm ( check all that apply and indicate state tax resale certificate number, if applicable):
                        STATE




                                                                           STATE




                                                                                                                             STATE




                                                                                                                                                                                STATE
                                Tax Resale Cert #:                                 Tax Resale Cert #:                                Tax Resale Cert #:                                 Tax Resale Cert #:

                          ALABAMA                                             IOWA                                             NEBRASKA                                           UTAH


                          ALASKA                                              KANSAS                                           NEW JERSEY                                         VERMONT


                          ARKANSAS                                            KENTUCKY                                         NEW MEXICO                                         VIRGIN ISLANDS


                          ARIZONA                                             LOUSIANA                                         NEVADA                                             VIRGINIA
CHECK ALL THAT APPLY




                          CALIFORNIA                                          MAINE                                            NEW YORK                                           WASHINGTON


                          COLORADO                                            MARYLAND                                         OHIO                                              WEST VIRGINIA


                          CONNETICUT                                          MASSACHUSETTS                                    OKLAHOMA                                           WISCONSIN


                          DELAWARE                                            MICHIGAN                                         OREGON                                             WYOMING


                          FLORIDA                                             MINNESOTA                                        PENNSYLVANIA                                       DISTRICT OF COLUMBIA


                          GEORGIA                                            MISSISSIPPI                                       RHODE ISLAND                                       PROVIDENCE


                          HI                                                  MISSOURI                                         SOUTH CAROLINA


                          IDAHO                                               MONTANA                                          SOUTH DAKOTA


                          INDIANA                                             NORTH CAROLINA                                   TENNESSEE


                          ILLINOIS                                            NORTH DAKOTA                                     TEXAS


                       The undersigned further certifies that if any property so purchased is used by the firm as to make it subject to a Sales or Use Tax, the purchaser will pay
                       the tax due directly to the proper taxing authority when the state law so provides or inform the seller for added tax billing. This certificate shall continue
                       in force until revoked and shall be part of each order given to the above named vendor, unless otherwise specified.

                        NAME OF FIRM:                                                                                   BY-PRINTED NAME


                        BUYERS NAME:                                                                                    SIGNATURE:

                        ADDRESS:                                                                                        TITLE:

                        PURCHASER'S ACTIVITY, I.E. RETAILING,                                                           DATE SIGNED:
                        WHOLESALING, MANUFACTURER, ETC.:

                        REVISION DATE: 1/29/02

				
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