STATE OF RHODE ISLAND 
   DEPARTMENT OF REVENUE – DIVISION OF TAXATION 
                                 SALES AND USE TAX 
                                          
   RESALE CERTIFICATE 
                                          
I HEREBY CERTIFY under penalties of perjury that I hold valid Permit to Make Sales at 
Retail No. ________________ issued pursuant to the Rhode Island Sales and Use Tax 
Act, 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 of 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 the above Act to report and pay tax, measured by the 
purchase price of such property. 
 
Description of property to be purchased: 
 
   Name of Purchaser: ________________________________
 
   Address                             _________________________________ 
            
                                         _________________________________
 
dated _________________________, 20____ 
 
                                 Signature ________________________________