BLANKET CERTIFICATE OF TAX EXEMPTION
ONE ZENEX CIRCLE
CLEVELAND, OHIO 44146
PHONE: (440) 232-4155 | FAX: (440) 232-5101
Prescribed by the Tax Commissioner Under Rule No. TX-11-03
GENERAL INFORMATION
THE UNDERSIGNED HEREBY CLAIMS EXEMPTION TO PURCHASES OF TANGIBLE PERSONAL PROPERTY FROM
ON AND AFTER
AND CERTIFIES THAT THIS CLAIM IS BASED UPON THE PURCHASER'S PROPOSED USE OF THE ITEMS PURCHASED, THE ACTIVITY OF THE PURCHASER, OR BOTH, AS SHOW HEREON:
PURCHASER MUST STATE STATUTORY REASON FOR CLAIMING EXEMPTION OR EXCEPTION. THIS CERTIFICATE SHALL CONTINUE IN FORCE UNTIL REVOKED AND SHALL BE CONSIDERED A PART OF EACH ORDER GIVEN TO THE ABOVE NAME VENDOR UNLESS THE ORDER SPECIFIES OTHERWISE
Statement
Purchaser
Name
Activity
Address
City
State
Zip
Vendors Licence
Check this box to approve your typed name in the above signature box as your signature
Check this box if you agree to all of the terms and conditions set forth in this document
AUTHORIZATION
Date
Company
Signature of Officer
Title
i.e: Manufacturer, Public Utility, Church, etc.
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