STATE OF RHODE ISLAND - DIVISION OF TAXATION 
 
                                                    SALES AND USE TAX 
 
 RESEARCH AND DEVELOPMENT EXEMPTION CERTIFICATE 
 
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(Name of Seller)                                                         (Date) 
 
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                                                    (Address) 
 
Under  penalties  of  perjury,  I  (we)  hereby  certify  that  the  property described herein is  
purchased for the purpose of being used for research and  development  having  as  its  ultimate   
goal  the  development  of  new products,  the  improvement  of  existing  products,  the   
development  of  new uses for existing products or the development or improvement of methods for  
producing products by a qualifying firm and is exempt from the sales or use tax pursuant to  
Chapter 18, Section 30 (42) of the Rhode Island sales and use tax law. 
 
DESCRIPTION OF PROPERTY:  
 
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If the tangible personal property purchased under this certificate is used to any extent in a  
taxable manner, I (we) agree to file the appropriate use tax returns as required by Regulation  
280-RICR-20-70-59 and the Rhode Island sales and use tax law. 
 
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                          Signature of Purchaser or Agent 
 
________________________________________________________________________________ 
                                                    Address of Purchaser 
 
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 If Corporation, give Name and Title of Corporate Officer 
 
Check applicable:  Single Purchase Certificate [  ] 
 
          Blanket Certificate               [  ] 
 
 THIS FORM IS APPROVED BY THE DIVISION OF TAXATION AND MAY BE REPRODUCED.