Return
to Previous PageResale Certificate
NAME OF PURCHASER:____________________________________________________________________
ADDRESS OF PURCHASER:________________________________________________________________
I hereby certify that: I hold a valid seller's permit No._________________________________________________
issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling__________________
_______________________________________________________________________________________
that the tangible personal property described
herein which I shall purchase from:__________________________
will be resold by me in the form of tangible personal property; provided, however
that in the event
any such property is used for any purpose other than retention, demonstration,
or display while
holding it for sale in the regular course of business, it is understood that
I am required by Sales and
use Tax Law to report and pay tax, measured by the purchase price of such property.
Description of Property to be purchased:_______________________________________________
______________________________________________________________________________
______________________________________________________________________________
Date:____________________________________
Phone No.: (____)_________________________
__________________________________
(Printed name of Purchaser
or Authorized Agent, and Title)
_________________________________
(Signature of Purchaser or
Authorized Agent)