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DocuSign Envelope ID:07A4359F-6D47-4987-B1F1-BF667ACBB3BA <br /> SALES TAX REPORT FROM TO <br /> PROJECT: <br /> CONTRACTOR: OWNER: <br /> FOR PERIOD , 20 TO 120 <br /> COUNTY NAME OF <br /> VENDOR ADDRESS INVOICE DATE AMOUNT N.C. TAX TAX COUNTY <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 /> Signature Title <br /> Sworn to before me this day of , 20 . My commission expires , 20 <br /> Notary Public ST - 1 <br />