©2000 Model City
Tax Code

REGULATIONS - PRIVILEGE AND EXCISE TAXES

Reg. ___-360.2. Proof of exemption: exemption certificate.

For the purpose of proof of exemption, in transactions other than those in which the proof is set by standard documentation as detailed in Regulations ___-350.1 and ___-360.1, the minimum acceptable proof and documentation for each transaction shall be the completion, at the time of the transaction, in all material respects, of a certificate containing all the information set forth below. For the purpose of validating the vendor's claim of exemption, such certificate is sufficient if executed by any person with apparent authority to act for the customer, and the information provided validates the claim.

VENDOR'S NAME ___________________________________
Sales Invoice No. ________

Customer's Business Name: __________________________________________________

Customer's Business Address: __________________________________________________

Specific Business Activity: __________________________________________________

(e.g., if retailer, lessor, or

manufacturer, specify items __________________________________________________

leased, sold or made, i.e.,

cars, computers, clothes, etc.) __________________________________________________

Customer's License Nos. _________ City: ______________________
State: _________

ITEMS CLAIMED AS EXEMPT FROM TAX

____________________: All Items on This Invoice or Purchase Order.

____________________: Only Those Items Marked With an "E".

REASON FOR CLAIMED EXEMPTION:

____________________: The items claimed as exempt are sold, rented, leased, or licensed by the above named customer in the normal course of its business activity.

____________________: The items claimed as exempt are exempt from the City of __________________________ Privilege Tax for the following specific reason(s):

I certify that the above information is accurate to the best of my information and belief, and that I am authorized by the Customer above to acquire the items claimed as exempt on a tax-free basis on its behalf. I further understand that the making of a false or fraudulent claim to obtain a tax exemption is a Class One **(Model Option #14A: Class Two)** **(Model Option #14B: Petty Offense)** Misdemeanor under City Code Section ___-580.

__________________________________________

Name

______________________________

Date

__________________________________________

Title

Web. Rev. Date: 10-30-2000

©2001 Model City Tax Code 
All rights reserved.