USLBRegForms

8/13/2019 USLBRegForms

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Resale Certificates (for

sales tax exemption):

Hawaii G-17(for HI businesses only)

Illinois CRT-61

Indiana ST-105D

Massachusetts ST-4(for MA businesses only)

Multijurisdiction

New York ST-120

Vermont S-3

West Virginia CST280

Buyer Registration Form -

Licensed Business

Business License(must be automotive-related)

Tax License

Valid Photo Identification (with signature)

Bank Inquiry Letter

(for check writing authorization)

$200 Registration Fee

BUYER REGISTRATION CHECKLISTU.S. LICENSED BUSINESSES For registration with IAA, please submit the following:

Insurance Auto AuctionsBuyer Services

Two Westbrook Corporate Center,ste#500

Westchester, IL 60154

[email protected]: (708) 492-7999



BUYER REGISTRATION FORMLicensed Business

12.1.09 p. 1 of 2

BUYER INFORMATION

This registration will allow you to bid at all facilities where you meet state licensing requirements.

AUCTION CENTER LOGIN I.D.

This section needs to be completed if you wish to receive a password to access the Auction Center and to bid online (either proxy or live)

YES NO (if no, proceed to Licenses section)

AUCTION CENTER LOGIN I.D.

LOGIN NAME (4 to 15 letters or numbers, no spaces)

1st Choice: ____________________________________________________ 2nd Choice: _____________________________________________________

Email Address (required if YES is selected to “Auction Center Login I.D.”)

______________________________________________________________________________________________________________________________

GENERAL INFORMATION

Company Name: ________________________________________________________________________________________________________________

Owner Last Name: _______________________________________________ Owner First Name, M.I.: ___________________________________________

LOCATION (no P.O. Box)

Street Address: ________________________________________________________________________________________________________________

City: _________________________________________________ State: ____________ Zip: ______________________ Country: ___________________

Phone: _____________________________________ Fax: _____________________________________ Cell: ____________________________________

MAILING ADDRESS (if different than location)

Street Address or PO Box: ________________________________________________________________________________________________________


DRIVERS LICENSE (photocopy required)

DL Number: _________________________________________ State or Country: _____________________ Expiration Date: _________________________

SECONDARY PURPOSE for purchasing vehicles at IAA Dismantling/Selling Parts

Scrapping/Crushing/Recycling

Rebuilding/Repairing

Wholesale and/or Retail Sales

Exporting

Other _________________________________________

PRIMARY PURPOSE for purchasing vehicles at IAA Dismantling/Selling Parts

Scrapping/Crushing/Recycling

Rebuilding/Repairing

Wholesale and/or Retail Sales

Exporting

Other _________________________________________



BUYER REGISTRATION FORMLicensed Business

12.1.09 p. 2 of 2

LICENSES

Please list all that apply. Copies required.

The undersigned registered buyer (owner, partner, president) has read and agrees to be bound by the policies, terms, conditions and

information set forth in the Insurance Auto Auctions “Auction Rules”, and the “Terms of Use” for the IAA Website and acknowledges that

compliance with same is a condition to remaining a buyer in good standing with Insurance Auto Auctions.

Please submit completed and signed form, along with copies of required documents (licenses and driver’s license) to your

local Insurance Auto Auctions branch or mail, fax, or email to

Insurance Auto Auctions, ATTN: Buyer Services, Two Westbrook Corporate Center, Suite 500, Westchester, IL 60154

Fax: 708-492-7999, email: [email protected]

LICENSE TYPE

LICENSE TYPE

LICENSE NUMBER

LICENSE NUMBER

STATE OF ISSUE

STATE OF ISSUE

EXP. DATE

EXP. DATE

Dealer License:

Dismantler License:

Rebuilder License:

Tax License:

Federal Tax I.D.#:

Please list any other relevant licenses below.

Registered Buyer Signature: Date:



COMPANY CHECK APPROVALBank Inquiry

11.09

BUYER INFORMATION

BANK INFORMATION

This form must be completed, signed, and mailed by your bank and include the official bank stamp.

Submit completed and signed form to

Insurance Auto Auctions

ATTN: Buyer Services

Two Westbrook Corporate Center, Suite 500


Fax 708-492-7999

e-mail [email protected]

Company Name: ________________________________________________________ Buyer Number: __________________________________________

Street Address: ________________________________________________________________________________________________________________


Phone: _____________________________________ Fax: _____________________________________

The undersigned authorizes bank to release information to Insurance Auto Auctions.

Owner/President Signature: _______________________________________________________ Date: ____________________________________

Bank Name: ________________________________________________________ Account Number: ____________________________________________

Street Address: ________________________________________________________________________________________________________________


Date Opened: _____________________________________ Average balance last 6 months: $_____________________________________

NSF History: Yes No If yes, date(s): __________________________________

Account has been maintained: Excellent Satisfactory Other, explain: _______________________________________________________

_____________________________________________________________________________________________________________________________

Signature: ____________________________________________

Date: ________________________________________________

Title: ________________________________________________

Phone: _______________________________________________

Bank Stamp



ADDITIONAL STATE LICENSING REQUIREMENTS

ADDITIONAL STATE LICENSING REQUIREMENTS

With most IAA locations, you can purchase the majority of vehicles sold through that facility as long as you have a dealer, dismantler,salvage, junk, scrapper, rebuilder or related license. Of course, the laws that say which type of license can purchase which type of title,varies by state and sometimes, locality.

In addition, some states require that you purchase specific licensing from that state in order to purchase certain titles and/or have accessto the salvage pools in that state. We understand this can be confusing, so here is a listing of these states (where IAA operates), theirrequirements and who to contact in that state to obtain the necessary licensing.

Alabama:

Nevada:

License: Alabama Buyer Identification Card (BID Card)

How to Apply: Call Alabama Department of Revenue, Sales, Use,

Business & Tax Division – Severance & License Section at 334-353-7827

or click on http://www.ador.state.al.us/licenses/LIC-756-3.pdf

Who’s Eligible: Buyers and their agents who meet Alabama state

requirements and wish to purchase Salvage title at any of our Alabama

locations.Available to Non-US Based Buyers: No.

Fee: $10 per card

License: Nevada Business Identification Card (Bid Card)

How to Apply: Click on http://www.dmv.nv.gov/pdfforms/obl252.pdf or call the

Nevada DMV at 775-684-4690

Applies to: Nevada based businesses only that wish to purchase vehicles in

IAA’s Nevada’s locations. This license does not apply to non-Nevada based

businesses.

Fees: Original and duplicate dealer and rebuilder ID cards, $50; renewal,

$25. All wrecker ID cards, $50.

Ohio:

License: Salvage Dealer Buyer Identification Card (BID Card)

How to Apply: Click http://bmv.ohio.gov/dealer_licensing/salvage-dea

buyer-id-card.htm and click on the application links or contact a BMV off

http://bmv.ohio.gov/dealer_licensing/contact-dealer-licensing.htm

Applies to: Buyers and/or their employees who meet Ohio st

requirements and wish to purchase any Salvage titles or Bill of Sale-FDestruction Only vehicles at any of our Ohio locations. See list of

requirements by state at http://bmv.ohio.gov/dealer_licensing/salva

dealer-buyer-id-card.htm *Not all states meet Ohio requirements.

Fee: $35 per licensing term.

Available to Non-US Based Buyers: No.

Utah:

Michigan:

License: Salvage Buyer Identification Card (BID Card)

How to Apply: Call Utah MVED (Motor Vehicle Enforcement Division)

801-297-2600 or click on http://mved.utah.gov/licensesalvage.html

Applies to: Utah based businesses and their agents who meet Utah sta

requirements and wish to purchase Certificate of Sale, Dismantling Perm

Junk Permit and Salvage Title at our Utah locations.

Fee: $203 for licensing year.* The SVA photograph must be taken at an authorized Michigan licensinglocation. Fingerprinting must be done at a Michigan police station.

Available to Non-US Based Buyers: Yes.

License: Michigan SVA (Salvage Vehicle Agent) Card

How to Apply: Call Michigan Department of State at 888-767-6424

Applies to: Buyers and their agents who meet Michigan state requirements

and wish to purchase Salvage or Scrap title in our Michigan locations.

Buyers must obtain the wall license and the photo ID card to be eligible to

purchase these tiles at the Michigan salvage pools.

Fee: $50 for SVA ID Card; $160 for wall certificate. After July 1st, wall

certificate is prorated at $80. $49.25 for fingerprinting for non-MI businesses;

for in-state fingerprinting cost will vary by location.

Wisconsin:

License: Wisconsin MV Business Individual Credential with BID

endorsement.

How to Apply: Call Wisconsin DMV at 608-266-1425 or click

http://www.dot.wisconsin.gov/business/dealers/forms/mv2651.pdf .

Applies to: Buyers and their agents who meet Wisconsin state requireme

and wish to purchase motor vehicles at any of our Wisconsin locations.

Fee: In –State - $6, if dealer license expires less than one year; $12 if dea

license expires over a year; Out-of-State/Out-of-Country - $6.

Available to Non-US Based Buyers: Yes, as long as the buyer meets

Wisconsin state requirements.


ATTN: Buyer Services

Two Westbrook Corporate Center, Suite #500


Fax: 708-492-7999E-mail [email protected]

7.5.11



FORM G-17

(REV. 2005)

STATE OF HAWAII — DEPARTMENT OF TAXATION

RESALE CERTIFICATE FOR GOODS

GENERAL FORM 1

(PLEASE PRINT OR TYPE)

To

(Name of Seller)

(Address of Seller) (Date of this Certificate)

(City) (State) (ZIP Code)

The undersigned hereby certifies:

• That the Purchaser is the holder of Hawaii Tax Identification No. W __ __ __ __ __ __ __ __ - __ __ under the GeneExcise Tax Law and subject to the taxing jurisdiction of the State;

• That the nature and character of the Purchaser’s business is:

;

• That this Certificate, until revoked by notice in writing, shall apply to all purchases of tangible personal property which Purchaser shall purchase from the Seller named above except those orders which the Purchaser specifies by notice

writing that this Certificate does not apply;

• That all of the purchases of tangible personal property to which this Certificate applies:

are purchases for resale at retail under Chapter 237, Hawaii Revised Statutes (HRS); and/or

are purchases for resale at wholesale under Chapter 237, HRS;

• That the Purchaser, pursuant to Chapter 237, HRS, as amended, and Hawaii Administrative Rules, relating to res

certificates, sales at wholesale, and the exemption for initial wholesale sales of property imported for further resalewholesale, shall pay to the seller, the amount of any additional tax imposed upon the seller with respect to any transactiocovered by this certificate; AND

• Further certifies to the foregoing as Purchaser or as an authorized agent or representative of the named Purchaser under

penalties set forth in section 231-36, HRS.

Name of Purchaser Signature

Address of Purchaser Print Name of Signatory

City State Zip Code Title (Owner, Partner or Member, Officer, or Duly Authorized Agent) Date

Seller should retain this Certificate for Seller’s files. Do NOT send to the Department of Taxation.

FORM G


91-445A Komohana Street

Kapolei HI 96707

Clear F



Illinois Department of Revenue

CRT-61 Certificate of Resale

Step 1: Identify the seller

1 Name __________________________________________

2 Business address _________________________________

_______________________________________________ City State Zip

Step 2: Identify the purchaser

3 Name __________________________________________

4 Business address _________________________________

_______________________________________________ City State Zip

5 Complete the information below. Check only one box.

The purchaser is registered as a retailer with the IllinoisDepartment of Revenue. __ __ __ __ - __ __ __ __ .

Registration number

The purchaser is registered as a reseller with the Illinois

Department of Revenue. __ __ __ __ - __ __ __ __ .

Resale number

The purchaser is authorized to do business out-of-state and

will resell and deliver property only to purchasers located

outside the state of Illinois. See Line 5 instructions.

Step 3: Describe the property

6 Describe the property that is being purchased for resale list the invoice number and the date of purchase.

_____________________________________________

_____________________________________________

_____________________________________________

Step 4: Complete for blanket certificate

7 Complete the information below. Check only one box.

I am the identified purchaser, and I certify that all of the

purchases that I make from this seller are for resale.

I am the identified purchaser, and I certify that the followingpercentage, ______ %, of all of the purchases that I make

from this seller are for resale.

Step 5: Purchaser’s signatureI certify that I am purchasing the property described in Step

from the stated seller for the purpose of resale.

___________________________________ _ _/_ _/_ _ Purchaser’s signature Date

Note: It is the seller’s responsibility to verify that thepurchaser’s Illinois registration or Illinois resale number isvalid and active.

General information

When is a Certificate of Resale required?Generally, a Cer tificate of Resale is required for proof that no taxis due on any sale that is made tax-free as a sale for resale. Thepurchaser, at the seller’s request, must provide the informationthat is needed to complete this certificate.

Who keeps the Certificate of Resale?The seller must keep the certificate. We may request it as proofthat no tax was due on the sale of the specified property.Do not mail the certificate to us.

Can other forms be used?

Yes. You can use other forms or statements in place of thiscertificate but whatever you use as proof that a sale was made forresale must contain

the seller’s name and address;the purchaser’s name and address;a description of the property being purchased;a statement that the property is being purchased for resale;the purchaser’s signature and date of signing; andeither an Illinois registration number, an Illinois resale number, ora certification of resale to an out-of-state purchaser.

Note: A purchase order signed by the purchaser may be used asa Certificate of Resale if it contains all of the above requiredinformation.

CRT-61 (R-04/02)IL-492-3850

When is a blanket certificate of resale used?

The purchaser may provide a blanket certificate of resale to anseller from whom all purchases made are sales for resale. A

blanket certificate can also specify that a percentage of thepurchases made from the identified seller will be for resale. Ineither instance, blanket certificates should be kept up-to-date. specified percentage changes, a new certificate should beprovided. Otherwise, all certificates should be updated at leastevery three years.

Specific instructions

Step 1: Identify the sellerLines 1 and 2 Write the seller’s name and mailing address.

Step 2: Identify the purchaserLines 3 and 4 Write the purchaser’s name and mailing address

Line 5 Check the statement that applies to the purchaser’sbusiness, and provide any additional requested information.Note: A statement by the purchaser that property will be sold fresale will not be accepted by the department without supportinevidence (e.g., proof of out-of-state registration).

Step 3: Describe the propertyLine 6 On the lines provided, briefly describe the tangiblepersonal property that was purchased for resale or list the invonumber and date of purchase.

Step 4: Complete for blanket certificatesLine 7 The purchaser must check the statement that applies,and provide any additional requested information.

Step 5: Purchaser’s signature

The purchaser must sign and date the form.


Two Westbrook Corporate Center, Suite 500

Westchester IL 60154



Indiana Department of Revenue

Resale Certificate of Exemption

Sales to a Licensed Vehicle, Trailer or Watercraft Dealer Only

by an Indiana Automobile Auction or an Indiana Licensed Dealer

Form

ST-105DState Form 51520

R2/ 5-05

This form is to be used only by an Indiana automobile auction or an Indiana dealer to reflect sales of motor

vehicles, trailers, or watercraft sold exempt from Indiana sales tax for purposes of the “resale” exemption per I.C

6-2.5-5-8. The purchasers claiming the exemption must be a licensed dealer in their state of residence and mustdisclose their Federal Identification Number (FID#) and their state of residence Dealer License Number on this

form, unless they possess an Indiana Taxpayer Identification Number (TID#). Failure to provide both numbers in

lieu of an Indiana TID# will void the claimed exemption and the selling auction or dealer must collect the Indiana

sales tax.

Purchaser’s Name

Address

City

State Zip

Phone # ( ) -

Is this a single purchase or blanket purchase exemption request? (Check One)

If single purchase indicate the VIN# or HIN#

Year, Make, and Model of single purchase

TID#

If not registered with IDOR, you must provide

both numbers below.

FID#

Dealer#

If this is a blanket purchase the certificate of exemption request is applicable to all purchases unless otherwise

instructed by the buyer.

I hereby certify under the penalties of perjury, that the property that is to be purchased by the use of this exemption

certificate will be used for the purpose of immediate “resale.”

If I am purchasing a new motor vehicle(s) for resale, I further certify that I possess a manufacturer’s new vehicle

dealer franchise to sell the type of vehicle purchased, as required per I.C. 6-2.5-5-8. Failure to possess a manufacturer’s

franchise to resell the type of vehicle being purchased, shall cause this exemption to become null and void. As a

purchaser, I will become liable for the sales/use tax on such purchase, including penalties and interest.

Purchaser’s Signature Title

Printed Name Date

Year Make Model

/ /

/ /

The Selling Auction or Selling Dealer must retain this form to document the exemption.

Indiana TID#

State of Residence Dealer#



Form ST-4Sales Tax Resale Certificate

Name of purchaser Social Security or Federal Identification number

Address

City/Town State Zip

Type of business in which purchaser is engaged:

Type of tangible personal property or service being purchased (be as specific as possible):

Name of vendor from whom tangible personal property or services are being purchased: INSURANCE AUTO AUCTIONS

Address: 1424 Lunenburg Rd. City/Town: Lancaster State: MA Zip: 01523

I hereby certify that I hold a valid Massachusetts Vendor’s Registration, issued by the Commissioner of Revenue, pursuant to Massachusetts General

Laws, Chapter 64H, section 7, and that I am in the business of selling the kind of tangible personal property or services being purchased under this

certificate, and that I intend to sell such property or services in the regular course of my business.

Signed under the penalties of perjury.

Signature of purchaser Title Date

Check applicable box: Single purchase certificate Blanket certificate

Rev. 8/00

Massachusetts

Department of

Revenue

Notice to Vendors

1. Massachusetts General Laws assume that all gross receipts ofa vendor from the sale of tangible personal property and servicesare from sales subject to tax, unless the contrary is established. Theburden of proving that a sale of tangible personal property or serviceby any vendor is not a retail sale is placed upon the vendor unlesshe/she accepts from the purchaser a certificate declaring that theproperty or service is purchased for resale.

2. A resale certificate relieves the vendor from the burden of proofonly if it is taken in good faith from a purchaser who is engaged inthe business of selling tangible property or services and who holdsa valid Massachusetts sales tax registration.

3. The good faith of the vendor will be questioned if he/she hasknowledge of facts which give rise to a reasonable inference that thepurchaser does not intend to resell the property or services. For ex-ample, knowledge that a purchaser of particular merchandise is notengaged in the business of selling the kind of merchandise or servicehe/she is purchasing under this certificate would constitute groundsto question the good faith of the vendor.

4. The vendor must make sure that the certificate is filled out prop-erly and signed before accepting it.

5. The vendor must retain this certificate as part of his/her perma-nent tax records.

If you have any questions about the acceptance or use of this cer-tificate, please contact:Massachusetts Department of RevenueCustomer Service BureauPO Box 7010Boston, MA 02204(617) 887-MDOR or toll-free, in-state 1-800-392-6089.

Notice to Purchasers

1. This certificate is to be used when the purchaser intends to resellthe tangible personal property or service in the regular course ofbusiness. Manufacturers claiming an exempt use of the materials,tools and fuel which will be used in the manufacture, processing orconversion of tangible personal property should use Form ST-12,Exempt Use Certificate. Tax-exempt organizations making pur-chases for other than resale are to use Form ST-5, Exempt Pur-

chaser Certificate.

2. The purchaser must hold a valid Massachusetts vendor regis-tration. If you need to apply for a registration, please completeand file Massachusetts Form TA-1, Application for Original Regis-tration. Form TA-1 may be obtained at any DOR office or by calling(617) 887-MDOR or toll-free, in-state 1-800-392-6089.

3. This certificate must be signed by and bear the name and ad-dress of the purchaser and his/her Federal Identification number.This certificate must also indicate the type of tangible personalproperty purchased and resold by the purchaser.

4. If a purchaser who gives a certificate makes any use of the prop-erty other than retention, demonstration or display while holding it forsale in the regular course of business, such property will be subjectto the Massachusetts sales or use tax, as of the time the property is

first used by him/her.

5. If you are engaged in a service activity, and are unsure as to theeligibility of the tangible personal property being purchased for re-sale, see the regulation on Service Enterprises, 830 CMR 64H.1.1.

6. For further information about the use of resale certificates,see the regulation on Resale and Exempt Use Certificates, 830CMR 64H.8.1.

Warning: Willful misuse of this certificate may result in criminaltax evasion sanctions of up to one year in prison and $10,000($50,000 for corporations) in fines.

This form is approved by the Commissioner of Revenue and may be reproduced.



Revised 12/2011

Page 1 of 4

UNIFORM SALES & USE TAX CERTIFICATE — MULTIJURISDICTION

The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on pages 2-4. 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: ________________________________________________________________________________________

Address: _____________________________________________________________________________________________

I certify that: is engaged as a registered

Name of Firm (Buyer): ________________________________ Wholesaler

Address: ___________________________________________ Retailer

__________________________________________________ Manufacturer

__________________________________________________ Seller (California)

__________________________________________________ Lessor (see notes on pages 2-4)

_________________________________________________________ Other (Specify)_____________

and is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are forwholesale, resale, ingredients or components of a new product or service1 to be resold, leased, or rented in the normal course of business. We are in

the business of wholesaling, retailing, manufacturing, leasing (renting) the following:

Description of Business: ____________________________________________________________________________________________

General description of tangible property or taxable services to be purchased from the seller: _______________________________________

________________________________________________________________________________________________________________

State State Registration, Seller’s Permit, or ID

Number of Purchaser

State State Registration, Seller’s Permit, or ID

Number of Purchaser

AL ___________________________________ MO ____________________________________

AR ___________________________________ NE ____________________________________AZ2 ___________________________________ NV ____________________________________CA ___________________________________ NJ ____________________________________CO ___________________________________ NM , ____________________________________

CT ___________________________________ NC ____________________________________DC6 ___________________________________ ND ____________________________________FL OH ____________________________________

GA ___________________________________ OK ____________________________________HI , ___________________________________ PA ____________________________________

ID ___________________________________ RI ____________________________________IL , ___________________________________ SC ____________________________________IA ___________________________________ SD ____________________________________

KS ___________________________________ TN ____________________________________KY ___________________________________ TX ____________________________________ME ___________________________________ UT ____________________________________MD ___________________________________ VT ____________________________________

MI14 ___________________________________ WA26 ____________________________________MN ___________________________________ WI ____________________________________

I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or use Tax wewill pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax bi lling. This certificate shall

be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state.

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: _______________________________________________________________(Owner, Partner or Corporate Officer)

Title: ____________________________________________________________________________

Date: ____________________________________________________________________________


Two Westbrook Corporate Center, Suite 500, Westchester, IL 60154



Revised 12/2011

Page 2 of 4

INSTRUCTIONS REGARDING UNIFORM SALES & USE TAX CERTIFCATE

To Seller’s Customers:

In order to comply with the majority of state and local sales tax law requirements, the seller must have in its files a properly executed

exemption certificate from all of its customers who claim a sales tax exemption. If the seller does not have this certificate, it is obliged

to collect the tax for the state in which the property or service is delivered.

If the buyer is entitled to sales tax exemption, the buyer should complete the certificate and send it to the seller at its earliest

convenience. If the buyer purchases tax free for a reason for which this form does not provide, the buyer should send the seller itsspecial certificate or statement.

Caution to Seller:

In order for the certificate to be accepted in good faith by the seller, seller must exercise care that the property or service being sold is

of a type normally sold wholesale, resold, leased, rented or incorporated as a ingredient or component part of a product manufactured

by buyer and then resold in the usual course of its business. A seller failing to exercise due care could be held liable for the sales tax

due in some states or cities. Misuse of this certificate by seller, lessee, or the representative thereof may be punishable by fine,

imprisonment or loss of right to issue certificate in some states or cities.

_______________________________ Notes:

1. Alabama: Each retailer shall be responsible for determining the validity of a purchaser’s claim for exemption.

2. Arizona: This certificate may be used only when making purchases of tangible personal property for resale in the ordinary

course of business, and not for any other statutory deduction or exemption. It is valid as a resale certificate only if it contains

the purchaser’s name, address, signature, and Arizona transaction privilege tax (or other state sales tax) license number, as

required by Arizona Revised Statutes § 42-5022, Burden of proving sales not at retail .

3. California: A. This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject

to the provisions of Title 18, California Code of Regulations, Section 1668 (Sales and Use Tax Regulation

1668, Resale Certificate).

B. By use of this certificate, the purchaser certifies that the property is purchased for resale in the regular course

of business in the form of tangible personal property, which includes property incorporated as an ingredient

or component part of an item manufactured for resale in the regular course of business.

C. When the applicable tax would be sales tax, it is the seller who owes that tax unless the seller takes a timely

and valid resale certificate in good faith.

D. A valid resale certificate is effective until the issuer revokes the certificate.

4. The state of Colorado, Hawaii, Illinois, and New Mexico do not permit the use of this certificate to claim a resale exemption for

the purchase of a taxable service for resale.

5 Connecticut: This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to

Conn. Gen. State §§12-410(5) and 12-411(14) and an regulations and administrative pronouncements pertaining to resale

certificates.

6. District of Columbia: This certificate is not valid as an exemption certificate. It is not valid as a resale certificate unless it

contains the purchaser’s D.C. sales and use tax registration number.

7. Florida: The Department will allow purchasers to use the Multistate Tax Commission’s Uniform Sales and Use Tax

Certificate-Multijurisdiction. However, the use of this uniform certificate must be used in conjunction with the telephonic or

electronic authorization number method described in paragraph (3)(b) or (c) of rule SUT FAC 12A-1.039..

8. Georgia: the purchaser’s state of registration number will be accepted in lieu of Georgia’s registration number when the

purchaser is located outside Georgia, does not have nexus with Georgia, and the tangible personal property is delivered by drop

shipment to the purchaser’s customer located in Georgia.

9. Hawaii allows this certificate to be used by the seller to claim a lower general excise tax rate or no general excise tax, rather

than the buyer claiming an exemption. The no tax situation occurs when the purchaser of imported goods certifies to the seller,

who originally imported the goods into Hawaii, that the purchaser will resell the imported goods at wholesale. If the lower rate



Revised 12/2011

Page 3 of 4

or no tax does not in fact apply to the sale, the purchaser is liable to pay the seller the additional tax imposed. See Hawaii Dept.

of Taxation Tax Information Release No. 93-5, November 10, 1993, and Tax Information Release No. 98-8, October 30, 1998.

10. Use of this certificate in Illinois is subject to the provisions of 86 Ill. Adm. Code Ch.I, Sec. 130.1405. Illinois does not have an

exemption on sales of property for subsequent ease or rental, nor does the use of this certificate for claiming resale purchases of

services have any application in Illinois.

The registration number to be supplied next to Illinois on page 1 of this certificate must be the Illinois registration or resale

number; no other state’s registration number is acceptable.

“Good faith” is not the standard of care to be exercised by a retailer in Illinois. A retailer in Illinois is not required to determine

if the purchaser actually intends to resell the item. Instead, a retailer must confirm that the purchaser has a valid registration or

resale number at the time of purchase. If a purchaser fails to provide a certificate of resale at the time of sale in Illinois, the

seller must charge the purchaser tax.

While there is no statutory requirement that blanket certificates of resale be renewed at certain intervals, blanket certificates

should be updated periodically, and no less frequently than every three years.

11. Kentucky: 1. Kentucky does not permit the use of this certificate to claim a resale exclusion for the purchase of a taxable

service.

2. This certificate is not valid as an exemption certificate. Its use is limited to use as a resale certificate subject to the

provisions of Kentucky Revised Statute 139.270 (Good Faith).

3. The use of this certificate by the purchaser constitutes the issuance of a blanket certificate in accordance with

Kentucky Administrative Regulation 103 KAR 31:111.

12. Maine does not have an exemption on sales of property for subsequent lease or rental.

13. Maryland: This certificate is not valid as an exemption certificate. However, vendors may accept resale certificates that bear the

exemption number issued to a religious organization. Exemption certifications issued to religious organizations consist of 8

digits, the first two of which are always “29”. Maryland registration, exemption and direct pay numbers may be verified on the

website of the Comptroller of the Treasury at www.marylandtaxes.com.

14 Michigan: Effective for a period of four years unless a lesser period is mutually agreed to and stated on this certificate. Covers

all exempt transfers when accepted by the seller in “good faith” as defined by Michigan statute.

15. Minnesota: A. Does not allow a resale certificate for purchases of taxable services for resale in most situations.

B. Allows an exemption for items used only once during production and not used again.

16. Missouri: A. Purchases who improperly purchase property or services sales tax free using this certificate may be

required to pay the tax, interest, additions to tax or penalty.

B. Even if property is delivered outside Missouri, facts and circumstances may subject it to Missouri tax,

contrary to the second sentence of the first paragraph of the above instructions.

17. Nebraska: A blanket certificate is valid 3 years from the date of issuance.

18. New Mexico: For transactions occurring on or after July 1, 1998, New Mexico will accept this certificate in lieu of a New

Mexico nontaxable transaction certificate and as evidence of the deductibility of a sale tangible personal property provided:

a) this certificate was not issued by the State of New Mexico;

b) the buyer is not required to be registered in New Mexico; and

c) the buyer is purchasing tangible personal property for resale or incorporations as an ingredient or component part into a

manufactured product.

19. North Carolina: This certificate is not valid as an exemption certificate or if signed by a person such as a contractor who

intends to use the property. Its use is subject to G.S. 105-164.28 and any administrative rules or directives

pertaining to resale certificates.

20. Ohio: A. The buyer must specify which one of the reasons for exemption on the certificate applies. This may be done by

circling or underlining the appropriate reason or writing it on the form above the state registration section.

Failure to specify the exemption reason will, on audit, result in disallowance of the certificate.

http://www.marylandtaxes.com/






Revised 12/2011

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B. In order to be valid, the buyer must sign and deliver the certificate to the seller before or during the period for

filing the return.

21. Oklahoma would allow this certificate in lieu of a copy of the purchaser’s sales tax permit as one of the elements of “properly

completed documents” which is one of the three requirements which must be met prior to the vendor being relieved of liability .

The other tow requirements are that the vendor must have the certificate in his possession at the time the sale is made and must

accept the documentation in good faith. The specific documentation required under OAC 710-:65-7-6 is:

A) Sales tax permit information may consist of:

(i) A copy of the purchaser’s sales tax permit; or

(ii) In lieu of a copy of the permit, obtain the following:

(I) Sales tax permit number; and

(II) The name and address of the purchaser;

B) A statement that the purchaser is engaged in the business of reselling the articles purchased;

C) A statement that the articles purchased are purchased for resale;

D) The signature of the purchaser or a person authorized to legally bind the purchaser; and

E) Certification on the face of the invoice, bill or sales slip or on separate letter that said purchaser is engaged in reselling the

articles purchased.

Absent strict compliance with these requirements, Oklahoma holds a seller liable for sales tax due on sales where the claimed

exemption is found to be invalid, for whatever reason, unless the Tax Commission determines that purchaser should be pursued

for collection of the tax resulting from improper presentation of a certificate.

22. Pennsylvania: This certificate is not valid as an exemption certificate. It is valid as a resale certificate only if it contains the

purchaser’s Pennsylvania Sales and Use Tax eight-digit license number, subject to the provisions of 61 PA

Code §32.3.

23. Rhode Island allows this certificate to be used to claim a resale exemption only when the item will be resold in the same form.

They do not permit this certificate to be used to claim any other type of exemption.

24. South Dakota: Services which are purchased by a service provider and delivered to a current customer in conjunction with the

services contracted to be provided to the customer are claimed to be for resale. Receipts from the sale of a service for resale by

the purchaser are not subject to sales tax if the purchaser furnishes a resale certificate which the seller accepts in good faith. In

order for the transaction to be a sale for resale, the following conditions must be present:

(1) The service is purchased for or on behalf of a current customer;(2) The purchaser of the service does not use the service in any manner; and

(3) The service is delivered or resold to the customer without any alteration or change.

25. Texas: Items purchased for resale must be for resale within the geographical limits of the United States, its territories and

possessions.

26. Washington: A. Blanket resale certificates must be renewed at intervals not to exceed four years;

B. This certificate may be used to document exempt sales of “chemicals to be used in processing an article to be

produced for sale.”

C. Buyer acknowledges that the misuse of the tax due, in addition to the tax, interest, and any other penalties

imposed by law.

27. Wisconsin allows this certificate to be used to claim a resale exemption only. It does not permit this certificate to be used to

claim any other type of exemption.



New York State Department of Taxation and Finance

New York State and Local Sales and Use Tax

Resale Certificate

Mark an X in the appropriate box: Single-use certificate Blanket certificate

Temporary vendors must issue a single-use certificate.

ST-12 (1/

Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make thstatements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use tado not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evaany such tax may constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentencunderstand that this document is required to be filed with, and delivered to, the vendor as agent for the Tax Department for the purposes of Law section 1838 and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. I aunderstand that the Tax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of ainformation entered on this document.

Name of seller Name of purchaser

Street address Street address

City State ZIP code City State ZIP code

Purchaser information – please type or print

I am engaged in the business of and principally sell

(Contractors may not use this certificate to purchase materials and supplies.)

Part 1 – To be completed by registered New York State sales tax vendors

I certify that I am:

a New York State vendor (including a hotel operator or a dues or admissions recipient), show vendor or entertainment vendor. My

valid Certificate of Authority number is

a New York State temporary vendor. My valid Certificate of Authority number is and expires on

I am purchasing:

A. Tangible personal property (other than motor fuel or diesel motor fuel)

• for resale in its present form or for resale as a physical component part of tangible personal property;

• for use in performing taxable services where the property will become a physical component part of the property upon which

services will be performed, or the property will actually be transferred to the purchaser of the taxable service in conjunction with

performance of the service; or

B. A service for resale, including the servicing of tangible personal property held for sale.

Part 2 – To be completed by non-New York State purchasers

I certify that I am not registered nor am I required to be registered as a New York State sales tax vendor. I am registered to collect sales

tax or value added tax (VAT) in the following state/jurisdiction and h

been issued the following registration number (If sales tax or VAT registration is n

required and a registration number is not issued by your home jurisdiction, indicate the location of your business and write not applicable

the line requesting the registration number.)

I am purchasing:

C. Tangible personal property (other than motor fuel or diesel motor fuel) for resale, and it is being delivered directly by the seller to

customer or to an unaffiliated fulfillment services provider in New York State.

D. Tangible personal property for resale that will be resold from a business located outside New York State.

Type or print name and t itle of owner, partner, or authorized person of purchaser

Signature of owner, partner, or authorized person of purchaser Date prepared

Substantial penalties will result from misuse of this certificate.

To the purchaser:

You may not use this certificate to purchase items or services that are not for resale. If you purchase tangible personal property or service

for resale, but use or consume the tangible personal property or services yourself in New York State, you must report and pay the unpaid ta

directly to New York State. Any misuse of this certificate will result in tax liabilities and substantial penalty and interest.


66 Peconic Avenue

Medford NY 11763-3274



Need help?

Sales Tax Information Center: (518) 485-2889

To order forms and publications: (518) 457-5431

Text Telephone (TTY) Hotline (for persons with hearing and speech disabilities using a TTY): (518) 485-5082

Internet access: www.tax.ny.gov (for information, forms, and publications)

Form ST-120, Resale Certificate , is a sales tax exemption certificate.This certificate is only for use by a purchaser who:

A – is registered as a New York State sales tax vendor and has avalid Certificate of Authority issued by the Tax Department andis making purchases of tangible personal property (other thanmotor fuel or diesel motor fuel) or services that will be resold ortransferred to the purchaser’s customers, or

B – is not required to be registered with the New York State TaxDepartment;

– is registered with another state, the District of Columbia, a

province of Canada, or other country, or is located in a state,province, or country which does not require sellers to register forsales tax or VAT purposes; and

– is purchasing items for resale that will be either:

1) delivered by the seller to the purchaser’s customer or to anunaffiliated fulfillment service provider located in New YorkState, or

2) delivered to the purchaser in New York State, but resold froma business located outside the state.

Note: For purposes of 1) above, delivery by the seller includesdelivery in the seller’s own vehicle or by common carrier,regardless of who arranges for the transportation.

Non-New York State purchasers: registrationrequirementsIf, among other things, a purchaser has any place of business orsalespeople in New York State, or owns or leases tangible personalproperty in the State, the purchaser is required to be registered for NewYork State sales tax.

A business must register (unless the business can rebut the statutorypresumption as described in TSB-M-08(3.1)S, Additional Informationon How Sellers May Rebut the New Presumption Applicable tothe Definition of Sales Tax Vendor as Described in TSB-M-08(3)S )for New York State sales tax if the business enters into agreementswith residents of New York State under which the residentsreceive consideration for referring potential customers to thebusiness by links on a Web site or otherwise, and the valueof the sales in New York State made by the business throughthose agreements totals more than $10,000 in the precedingfour sales tax quarters. See TSB-M-08(3)S, New Presumption Applicableto Definition of Sales Tax Vendor, and TSB-M-08(3.1)S.

Also see TSB-M-09(3)S, Definition of a Sales Tax Vendor is Expandedto Include Out-of-State Sellers with Related Businesses in NewYork State, for information on sales tax registration requirements forout-of-state businesses with New York affiliates.

A purchaser who is not otherwise required to be registered for New YorkState sales tax may purchase fulfillment services from an unaffiliated New York fulfillment service provider and have its tangible personalproperty located on the premises of the provider without being requiredto be registered for sales tax in New York State.

If you need help determining if you are required to register because you engagein activity in New York State, contact the department (see Need help? ).

If you meet the registration requirements and engage in businessactivities in New York State without possessing a valid Certificate ofAuthority, you will be subject to penalty of up to $500 for the first day on

which you make a sale or purchase, and up to $200 for each additionalday, up to a maximum of $10,000.

Limitations on useContractors cannot use this certificate. They must either:

• issue Form ST-120.1, Contractor Exempt Purchase Certificate , if thetangible personal property being purchased qualifies for exemptionas specified by the certificate, or

• issue Form AU-297, Direct Payment Permit , or

• pay sales tax at the time of purchase.

Contractors are entitled to a refund or credit of sales tax paid onmaterials used in repairing, servicing or maintaining real property, ifthe materials are transferred to the purchaser of the taxable servicein conjunction with the performance of the service. For additionalinformation, see Publication 862, Sales and Use Tax Classifications of

Capital Improvements and Repairs to Real Property .

ST-120 (1/11) (back) Instructions

To the PurchaserEnter all the information requested on the front of this form.

You may mark an X in the Blanket certificate box to cover all purchasof the same general type of property or service purchased for resaleIf you do not mark an X in the Blanket certificate box, the certificatewill be deemed a Single-use certificate . Temporary vendors may notissue a blanket certificate. A temporary vendor is a vendor (other thashow or entertainment vendor), who, in no more than two consecutivquarters in any 12-month period, makes sales of tangible personalproperty or services that are subject to tax.

This certificate does not exempt prepaid sales tax on cigarettes. Thiscertificate may not be used to purchase motor fuel or diesel motor fu

Misuse of this certificate

Misuse of this exemption certificate may subject you to serious civil acriminal sanctions in addition to the payment of any tax and interestdue. These include:

• A penalty equal to 100% of the tax due;

• A $50 penalty for each fraudulent exemption certificate issued;

• Criminal felony prosecution, punishable by a substantial fine and apossible jail sentence; and

• Revocation of your Certificate of Authority , if you are required tobe registered as a vendor. See TSB-M-09(17)S, Amendments thaEncourage Compliance with the Tax Law and Enhance the Tax

Department’s Enforcement Ability , for more information.

To the SellerIf you are a New York State registered vendor and accept an exemptdocument, you will be protected from liability for the tax, if the certificis valid.

The certificate will be considered valid if it was:

• accepted in good faith;

• in the vendor’s possession within 90 days of the transaction; and

• properly completed (all required entries were made).

A certificate is accepted in good faith when a seller has no knowledgthat the exemption certificate is false or is fraudulently given, andreasonable ordinary due care is exercised in the acceptance of thecertificate.

You must get a properly completed exemption certificate from yourcustomer no later than 90 days after the delivery of the property or thperformance of the service. When you receive a certificate after the90 days, both you and the purchaser are subject to the burden of provthat the sale was exempt, and additional documentation may be requiAn exemption certificate received on time that is not properly complewill be considered satisfactory if the deficiency is corrected within areasonable period. You must also maintain a method of associating ainvoice (or other source document) for an exempt sale made to a custowith the exemption certificate you have on file from that customer.

Invalid exemption certificates – Sales transactions which are notsupported by valid exemption certificates are deemed to be taxableretail sales. The burden of proof that the tax was not required to becollected is upon the seller.

Retention of exemption certificates - You must keep this certific

for at least three years after the due date of the return to which itrelates, or the date the return was filed, if later.



05451VTEssex

304 Colchester Road






WEST VIRGINIA CONSUMERS SALES AND SERVICE TAX AND USE TAX

EXEMPTION CERTIFICATECANNOT BE USED TO PURCHASE GA SOLINE OR SPECIAL FUEL

TO BE COMPLETED BY PURCHASER: I, the undersigned, hereby certify that I am making an exempt purchase and hold a valid Business Registration Certific

My principle business activity is

I claim an exemption for the following reason (Check applicable box or boxes):

PURCHASE FOR RESALE

Purchase of tangible personal property or taxable services for resale or for use in performing taxable services where such property become

component part of the property upon which the services are performed and will be actually transferred to the purchaser. WV Code § 11-15-9(a)

PURCHASE BY AN EXEMPT COMMERCIAL AGRICULTURAL PRODUCER

A. Purchase of tangible personal property or taxable services for use or consumption in the commercial production of an agricultural product.

not purchases for the construction of, or permanent improvement to real property or purchases of gasoline or fuel. WV Code § 11-15-9(a

B. Purchase of propane for use in poultry houses for heating purposes. WV Code § 11-15-9(a)(18)

TAX EXEMPT ORGANIZATIONS

A. GOVERNMENT - Purchases by governmental agencies and institutions of (1) the United States; (2) this State (including its local governmen

and (3) any other State (and its local governments) which provides this same exemption to this State. Such purchases by government employ

are not exempt unless they are on government business and are billed to and paid for directly by the government. Private persons doing busine

with government may not claim this exemption. WV Code § 11-15-9(a)(3)

B. CERTAIN NONPROFIT ORGANIZATIONS - Purchases by a corporation or organization which has a current registration certificate and which

exempt from federal income taxes under section § 501(c)(3) or (c)(4) of the Internal Revenue Code. These organizations must meet all of requirements set forth in WV Code § 11-15-9(a)(6). For information concerning these requirements refer to publication TSD-320.

WV Code § 11-15-9(a)(6)

C. SCHOOLS - Purchases by a school with its principal campus in this State which is approved by the State of West Virginia to award degrees a

which is exempt from federal and state income taxes under section § 501(c)(3) of the Internal Revenue Code. WV Code § 11-15-9(a)(15)

D. CHURCHES - Purchases of services, equipment, supplies, food for meals and materials directly used or consumed by churches which make

charge whatsoever for the services they render. The purchase must be paid for directly out of the church treasury. WV Code § 11-15-9(a

PURCHASES OF CERTAIN SPECIFIC SERVICES AND TANGIBLE PERSONAL PROPERTY

A. Purchases of electronic data processing services and related software but not data processing equipment, materials and supplies.

WV Code § 11-15-9(a)(21)

B. Purchases of services by one corporation, partnership or limited liability company from another corporation, partnership or limited liability comp

but only when the entities are members of the same controlled group or related taxpayers as defined in Section 267 of the Internal Revenue Co

WV Code § 11-15-9(a)(23)C. Purchases of computer hardware and software directly incorporated into manufactured products; certain leases; electronic data process

service; computer hardware and software directly used in communication; educational software; internet advertising; high technology busine

services directly used in fulfillment of a government contract. WV Code § 11-15-9h

D. Purchases of motion picture films, coin-operated video arcade machines and other video arcade games for any use upon which there will b

charge subject to sales tax. WV Code § 11-15-9(a)(32)

E. Purchases by a licensed carrier of persons or property, or by a government entity, of aircraft repair, remodeling and maintenance services

an aircraft, engine or other component part of an aircraft, or purchases of tangible personal property that is permanently affixed as a compon

part of an aircraft as part of the repair, remodeling or maintenance of aircraft, aircraft engines or aircraft component parts, and purchases

a licensed carrier of persons or property, or by a government entity, of machinery, tools or equipment, directly used or consumed exclusively

the repair, remodeling or maintenance of aircraft, aircraft engines or aircraft component parts. WV Code § 11-15-9(a)(33)

REVERSE SIDE OF EXEMPTION CERTIFICATE MUST BE COMPLETED TO BE CONSIDERED VALID

NAME OF VENDOR Insurance Auto Auctions

STREET ADDRESS 200 Auction Ln CITY Buckhannon STATE WV ZIP CODE 26201

CHECK APPLICABLE BOX:

SINGLE PURCHASE CERTIFICATE BLANKET CERTIFICATE

DATE

WV/CST-280

(Rev. 905)

All sales of tangible personal property or taxable services are presumed to be subject to tax unless a properly completed ExemptionCertificate or a Direct Pay Permit number is provided. Read instructions on reverse side before completing this certificate.

Enter Tax Identification Number



GENERAL INSTRUCTIONS

An Exemption Certificate may be used only to claim exemption from tax upon a purchase of tangible personal property or servicwhich will be used for an exempt purpose as stated on the front of this form.

A purchaser may file a blanket Exemption Certificate with the vendor to cover additional purchases of the same general type of propeor service. However, each subsequent sales slip or purchase invoice evidencing a transaction covered by a blanket ExemptCertificate must show the purchaser’s name, address and Business Registration Certificate Number for purposes of certificatio

INSTRUCTIONS FOR PURCHASER

To purchase tangible personal property or services tax exempt, you must possess a valid Business Registration Certificate and ymust properly complete this Exemption Certificate and present it to your supplier. To be properly completed, all entries on tExemption Certificate must be filled in.

Your Business Registration Certificate (and any duplicates) may be suspended or revoked if you or someone acting on your behwillfully issues this certificate for the purpose of making a tax exempt purchase of tangible personal property and/or services this not used in a tax exempt manner (as stated on the front of this form).

When property or services are purchased tax exempt with an Exemption Certificate, but later used or consumed in a non exemmanner, the purchaser must pay Sales or Use Tax on the purchase price.

The willful issuance of a false or fraudulent Exemption Certificate with the intent to evade Sales or Use Tax is a misdemeanor.

Your misuse of this Certificate with intent to evade the Sales or Use Tax shall also result in your being subject to:

A penalty of fifty percent of the tax that would have been duehad there not been a misuse of such certificate.

This is in addition to any other penalty imposed by the Law.

In the event you make false or fraudulent use of this Certificate with intent to evade the tax, you may be assessed for the tax at atime subsequent to such use.

INSTRUCTIONS FOR VENDOR

At the time the property is sold or the service is rendered, you must obtain from your customer this Certificate, properly complete(or a Direct Pay Permit number issued by the West Virginia Department of Tax and Revenue), or the sale will be deemed a taxasale, unless the property or service sold is exempt per se from Sales Tax. Your failure to collect tax on such taxable sale will mayou personally liable for the tax, plus penalties and interest.

Additional information may be required to substantiate that the sale was for exempt purposes. In order for this Certificate to be propecompleted, it must be issued by a purchaser who has a valid Business Registration Certificate and must have all entries completby the purchaser.

A timely received certificate which contains a material deficiency will be considered satisfactory if such deficiency is subsequen

corrected.You must keep this certificate for at least three years after the due date of the last return to which it relates, or the date when sureturn was filed, if later.

You must maintain a reasonable method of associating a particular exempt sale to a customer with the Exemption Certificate yhave on file for such customer.

INSTRUCTIONS FOR VENDOR AND PURCHASER

If you, as vendor or as a purchaser, engage in any business activity in West Virginia without possessing a valid Business RegistratCertificate (and you do not clearly qualify for an exemption), you shall be subject to a penalty in an amount not exceeding $100 the first day on which such sales or purchases are made, plus an amount not exceeding $100 for each subsequent day on whsuch sales or purchases are made.

Pl b i i thi C tifi t i di t l

NAME OF PURCHASER

SIGNATURE OF OWNER, PARTNER, OFFICER OF CORPORATION, ETC.

TITLE

STREET ADDRESS

CITY

STATE ZIP CODE

I understand that this certificate may not be used to make tax free purchases of items or services which are not for an exempt purpoand that I will pay the Consumers Sales or Use Tax on tangible personal property or services purchased pursuant to this certificaand subsequently used or consumed in a taxable manner. In addition, I understand that I will be liable for the tax due, plus substanpenalties and interest, for any erroneous or false use of this certificate.

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