STATE OF RHODE ISLAND 
                 DEPARTMENT OF REVENUE
                                      DIVISION OF TAXATION
                                      ONE CAPITOL HILL
                 PROVIDENCE, RI 02908-5800

                                      SALES AND USE TAX
                 WHOLESALER’S - RESALE CERTIFICATE

I HEREBY CERTIFY under penalties of perjury that I am engaged in the business of selling 

AT WHOLESALE ONLY; and the tangible 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 the Rhode Island Sales and Use Tax Act to report and pay 
                 tax, measured by the purchase price of such property.

Description of property to be purchased:

NAME OF PURCHASER

TITLE                                          TELEPHONE NUMBER

STREET

CITY OR TOWN                                         STATE     ZIP CODE

SIGNATURE                                                      DATE