New York Slate Department el

New York Slate Department el New York State and Resale Certificate Taxation and Finance Local Sales and Use Tax Name of seller Stark Carpet Corp Name or purchaser Street address 979 Third Avenue Street address City New York State ZIP code NY 10022 City State Mark an X in the appropriate bow O Single-use certificate O Blanket certificate Temporary vendors must issue a single-use certificate. 120 ? ZIP code 1 To the purchaser: You may not use this certificate to purchase items or services that are not for resale. If you purchase tangible personal property or services for resale, but use or consume the tangible personal properly or services yourself in New York State. you must report and pay the unpaid tax directly to New York State. Any misuse of this certificate will result in tax liabilities and substantial penalty and interest. Purchaser Information - please type or print I am engaged in the business of and principally sell (Contractors may not use this certificate to purchase materials and supplies.) Part 1 —To be completed by registered New York State sales tax vendors I certify that I am: K a New York State vendor (including a hotel operator or a dues or admissions recipient). show vendor or entertainment vendor. My valid Certificate of Authority number Is O a New York State temporary vendor. My valid Certificate of Authority number is and expires on I am purchasing: r I I A. Tangible personal property (other than motor fuel or diesel motor fuel) • for resale in its present form or for resale as a physical component part of tangible personal property; • for use in performing taxable services where the property will become a physical Component part of the property upon which the services will be performed, or the property will actually be transferred to the purchaser of the taxable service in conjunction with the performance of the service; or n B. A service for resale. including the servicing of tangible personal property held for sale. Part 2 —To be completed by non-New York State purchasers I certify that I am not registered nor am I required to be registered as a New York State sales tax vendor. I am registered to collect sales tax or value added tax (VAT) in the following state/jurisdiction and have been issued the following registration number (If sales tax or VAT registration is not required and a registration number is not issued by your home jurisdiction. indicate the location of your business and write not applicable on the line requesting the registration number.) I am purchasing: K C. Tangible personal property (other than motor fuel or diesel motor fuel) for resale, and it is being delivered directly by the seller to my customer or to an unaffiliated fulfillment services provider in New York State. El D. Tangible personal property for resale that will be resold from a business located outside New York State. Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted. I make these statements and issue this exemption certificate with the knowledge that this document provides evidence that state and local sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that willfully issuing this document with the intent to evade any such tax may constitute a felony or other crime under New York State Law, punishable by a substantial fine and a possible jail sentence. I understand that this document is required to be filed with, and delivered to, the vendor as agent for the Tax Department for the purposes of Tax Law section 1838 and is deemed a document required to be filed with the Tax Department for the purpose of prosecution of offenses. 1 also understand that the Tax Department is authorized to investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document. Type or print name and title of owner, partner, or authorized person of purchaser Signature of owner, partner, or authorized person of purchaser Date prepared Substantial penalties will result from misuse of this certificate. EFTA00523015