| Federal Tax Exemption Certificate
I, (name) _____________________________________________, hereby certify that I am the (title) ______________________ for (agency) ________________________________, and that I am authorized to execute this certificate, and that: The article or articles specified in the attached purchase order -OR- All orders placed by us for the period commencing ___________________, 20___ and ending ___________________, 19____ (not to exceed one year) are, or will be, purchased from Olympic Arms, Inc. and are for the exclusive use of (state name of agency or governmental unit) ___________________________ _______________________________________________________________________ I understand that the exemption from tax in the case of sales of articles under this exemption certificate to a state of local government unit is limited to the sale of articles for its exclusive use. I understand that fraudulent use of this certificate for the purpose of securing this exemption will subject me and all parties making use of this certificate to all applicable criminal penalties under the Internal Revenue Code. Signed this _________ day of _________________, 20____. X: __________________________________________________ Address: ________________________________________________________________ ________________________________________________________________________ Phone # (_______) _______ - ___________ Fax # (_______) _______ - ____________
• For the use of state and local governments under Section 4221(a)(4) if the Internal Revenue Code. |