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DocuSign Envelope ID: F95C199F-F97E-472F-8EC3-1 F88449C7DC7 <br /> E-559CI Affidavit of Capital Improvement <br /> Form E-589CI,Affidavit of Capital Improvement,is generally required to substantiate that a contract,or a portion <br /> of work to be performed to fulfill a contract,is to be taxed for sales and use tax purposes as a real property <br /> contract with respect to a capital improvement to real property. <br /> ■This affidavit may not be used to purchase building materials,other tangible personal property,or digital <br /> property to fulfill a real property contract exempt from sales and use tax. <br /> ■ A person who willtully attempts,or a person who aids or abets a person to attempt in any manner,to evade or <br /> defeat a tax imposed by the Sales and Use Tax Laws,or the payment thereof,shall be guilty of a Class H felony.If <br /> there is a deficiency or delinquency in payment of any tax due to fraud with intent to evade the tax,there shall be <br /> assessed a penalty equal to 50%of the total deficiency. <br /> Section I.Single Use(Complete this section to issue the affidavit for a single capital improvement.) <br /> Owner,Tenant,or Rea Property Contractor Real Property Contractor(Genera!Contra cto r o r Su boo ntractor) <br /> A ORANGE COUNTY B SEEGARS FENCE COMPANY,INC.OF DURHAM <br /> Address Address <br /> 131 W.MARGARET LANE P.O.Box 61378 <br /> city .. .ST ZIP .. City ST ZIP <br /> HILLSBOROUGH NC 27278 Durham NC. 2771-5 <br /> Describe capital improvement to be perfarmed: <br /> New Fence Installation <br /> Project Name <br /> HILL58OROUGH COMMON5 <br /> Project Address City ST ZIP <br /> 113 MAYO ST,HILLSBOROUGH,NC HILLSBOROUGH NC 27278 <br /> I certify that,to the best of my knowledge,this affidavit is accurate and complete and that the transaction described to be performed <br /> by the Real Property Contractor(General Contractor or subcontractor identified In box"B")shall be treated as a real property contract <br /> with respect to a capital Improvement to real property for sales and use tax purposes. <br /> DocuSigned by: <br /> �bsfbin- Director 3/11/2020 <br /> Signature of Authorized Person. � Title: Date: <br /> OAE1 E1 MA83B455... <br /> Section li.Blanket Use(Complete this section execute a blanket affidavit.) <br /> Real Property Contractor Real Pro p e rty Contra cto r or subcontractor) <br /> C d <br /> Address Address <br /> City ST ZIP city ST zip <br /> To be completed by the Real Property Contractor Identified in Box C. <br /> I certify that I am a Real Property Contractor who performs capital Improvements to real property and all transactions with the real <br /> property contractor(subcontractor)identified In box"D"shall be treated as real property contracts with respect to capital <br /> Improvements for real property for sales and use tax purposes. <br /> Signature of Authorized Person: Title: Date: <br />