TAX EXEMPTION CERTIFICATE-MULTIJURISDICTION/MULTI-TAX
The issuer and the recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may
change from time to time.
Issued to Seller: ____________________________________________________________________________________________________
I certify that: is engaged as a registered
Name of Firm (Buyer): _____________________________________ Wholesaler
Seller (California) ______________________________________
_____________________________________ Lessor (See notes
On pages 2-4) _______________________________________
_____________________________________ Other (Specify) _______________________________________
Purchaser certifies that is it is registered with the below listed taxing authorities within which your firm would deliver goods and/or services to us and
that any such purchases are for wholesale, resale, ingredients or components of a new product or service to be resold, leased, or rented in the normal
course of business. In addition to sales and use tax, the purchase warrants that it is exempt from federal excise tax, 911 and other taxes, fees and
surcharges that otherwise are only applicable to an end user of telecommunication services.
Description of Business: ________________________________________________________________________________________________
General description of tangible property or taxable services to be purchased from the seller: _____________________________________________
Federal Tax ID: __________________________________________________________________________________________________________
State State Registration, Seller’s State State Registration, Seller’s
Permit, or ID Number of Purchaser Permit, or ID Number of Purchaser
I further certify that if any goods and/or services so purchased tax free are used or consumed by the purchaser as to make it subject to taxes, fees or
surcharges, we will pay the taxes, fees or surcharges due directly to the proper taxing authority when the law so provides or inform the seller for
added tax billing. This certificate shall be a part of each order that we may hereafter give to you, unless otherwise specified, and shall be valid until
canceled by us in writing or revoked by the taxing authority.
Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter.
Authorized Signature: ___________________________________________
Mail form to: 100 CenturyTel Drive, Monroe, LA 71203
E-Mail form to: email@example.com