OFFICE OF STATE TAX COMMISSIONER                       Important:  Click this button to reset the form
CERTIFICATE OF RESALE
SFN 21950 (11-2002)

I hereby certify that I hold _______________ Sales and Use Tax permit number_________________.  I am engaged in the business
                              (State)
of selling, leasing or renting  _________________________________________________________________________________.
I further certify that the tangible personal property purchased from ___________________________________________________
is purchased by me for resale.
I further certify that I will report and remit any sales or use tax and any penalties which attach as a result of purchases from
the above seller which are used or consumed by me.

__________________________________________________ __________________________________________________
Business Name                                      Business Address
__________________________________________________ __________________________________________________
Authorized Signature                               Date

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