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SALES TAX REPORT FROM _________________________ TO ____ <br /> PROJECT: ____ <br />CONTRACTOR: _________________________________ OWNER: ____ <br /> FOR PERIOD _______________, 20___ TO _______________, 20___ <br /> <br /> <br />VENDOR <br /> <br />ADDRESS <br /> <br />INVOICE <br /> <br />DATE <br /> <br />AMOUNT <br /> <br />N.C. TAX <br />COUNTY <br />TAX <br />NAME OF <br />COUNTY <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> being duly sworn, certifies that the foregoing <br />statement of sales taxes paid in connection with the referenced contract is true to the best of his or her knowledge and belief. <br /> , <br /> Signature Title <br /> <br />Sworn to before me this __________ day of _____________, 20____. My commission expires __________________, 20____. <br /> <br /> <br />Notary Public ST - 1 <br />DocuSign Envelope ID: BBF56E0A-3618-497E-AA70-92F097E8F598