Orange County NC Website
Browse       Search
DocuSign Envelope ID: 7E107417-F9E7-4B2F-A30A-B4D250909DD9 <br /> E-595E Streamlined Sales and Use Tax Agreement <br /> mb-Fill <br /> 12-09 Certificate of Exemption <br /> This is a multhstate form. Not all states allow ail exemptions listed or this form Purchasers are responsible for knowing if they <br /> qualify to claim exemption from tax:Mlle state that would other be due tax on this sale.The sever may'ii it required to provide <br /> this exemption certificate or data elements required on the form)to a state that would otherwise be due tax on this sale. <br /> The purchaser will be held liable for any tax and interest,and possibly civil and criminal penalties imposed by the member state, <br /> If the purchaser is not eligible to claim this exemption: A seller may not accept a certificate of exemption for an entity-based <br /> exemption on a sale made at a location operated by the seller within the designated state if the state does not allow such an <br /> entitybased exemption.. <br /> 1 El Check if you are attaellingi the Multistate Supplemental form„ <br /> [ ..._.......„„„,,, <br /> NC ll If not,onto'the two-latter postal abbreviation for the state under whose laws you we claiming exemption. <br /> nr--- <br /> 2 Check it this certificate is for a single purchase and enter the related hvoicetpurchase order# <br /> „..,.„._ <br /> 3 Reece print <br /> brefWelbOrsenser – <br /> VO I C ES <br /> iiirFii""ilia iriiio _ <br /> c ily Slate — lip tack, „ <br /> PO 130X ,3011 CHAPEL HILL NC 2 7 1 5 <br /> ea;;TirEn;i7i lax ID cumber Smile of issue Cousin El issue „ <br /> NC USA <br /> _ <br /> If on tAY WI Iiiiiber, '''''''m 1 FEN [Driverslies s se numberatess iu seed ID osmium' Vertigo eiplemal number <br /> sew else el the Woven fr efule of fseire number <br /> i L „ <br /> Norm;of malleTEUM;b0 re y4)I roinnoryin,Moshe,er reefing <br /> &ekes address — .,s <br /> ofy State 7lp,00de <br /> 4 Type of bustriesL Check the number that describes your businessn <br /> 1,1, DI Aocommodation and food services 11 11 Transportation and warehousing <br /> 02 Agricultural,forestry,fishing, and hunting 0 12 Utilities <br /> m, construction E 13 Wholesale trade <br /> 0 04 Finance and insurance D 14 Birt.SitleaS cervices <br /> L1 0 Information,publishing, and communications [,j 15 Professional services <br /> 1:71 06 Manufacturing Ill 16 Education and health-care services <br /> U 07 Mining 'il 17 Nonprofit organization <br /> D 08 Real estate .1 1 Government <br /> 11 09 Rental arid leasing E] 19 Not El business <br /> II 10 Retail trade 11:1 20 Other(explain) .....„. ...........„„. <br /> 5 Reason for exemption.Check the letter that identifies the reason for the nexemption. <br /> El A Federal government rolenareneral .D lil Agricultural production# <br /> 111 B State government Name" _ El 1 Industrial producton/manufacturing# <br /> 1:ll C Tribal government mama) LI „.1 Direct pay permit)/ <br /> D Foreign diplomat it, , ri K Direct mail fat <br /> VI <br /> L. Other(exptatn) NOT FOR, PROFIT , <br /> Li C Resale# _ <br /> 6 Sign bora. P deefare that the information on rhis nedificate is coifed and compi'eta to the best of my knowiedge and belief <br /> Skamo 2.0rmatramizedltandifaser. <br /> Print mime flew <br /> hie <br /> . ."" <br /> . . .. 'ili,!POI 9-APA k 9,411\ -1}:. sv...,,., „,,.... v.)Ipo 19-0 4 <br /> 1; <br />