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E-589CI Affidavit of Capital Improvement <br />Section I. Single Use (Complete this section to issue the affidavit for a single capital improvement.) <br />Owner, Tenant, or Real Property Contractor Real Property Contractor (General Contractor or Subcontractor) <br />A B <br />Address Address <br />City ST ZIP City ST ZIP <br />NC NC <br />Describe capital improvement to be performed: <br />Project Name <br />Project Address City ST ZIP <br />NC <br />Signature of Authorized Person:Title:Date: <br />Section II. Blanket Use (Complete this section execute a blanket affidavit.) <br />Real Property Contractor Real Property Contractor 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 />Signature of Authorized Person:Title:Date: <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 improvements <br />for real property for sales and use tax purposes. <br />510 MEADOWLANDS DR., HILLSBOROUGH, NC HILLSBOROUGH 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 by <br />the Real Property Contractor (General Contractor or Subcontractor identified in box “B”) shall be treated as a real property contract with <br />respect to a capital improvement to real property for sales and use tax purposes. <br />EMERGENCY SERVICES <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 willfully 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 />ORANGE COUNTY Seegars Fence Company, Inc. of Durham <br />131 W. MARGARET LANE P.O. Box 61378 <br />HILLSBOROUGH 27278 Durham 27715 <br />New Fence Installation <br />DocuSign Envelope ID: 9F4142C4-00F4-4375-B376-01576520EC80