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Issued to Seller Address Name of Firm Buyer I CERTIFY THAT Street Address or Post Office Box Number City State WHOLESALER QUALIFIES AS Check each applicable item RETAILER LESSOR See note on reverse side MANUFACTURER POLITICAL SUBDIVISION OR GOVERNMENTAL AGENCY ZIP Code CHARITABLE OR RELIGIOUS OTHER Specify and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is of sales or use tax in such states and cities because the buyer is or that such purchases are exempt from payment OTHERWISE EXEMPT BY STATUTE SPECIFY City or State State Registration or ID Number I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax we will pay the tax due direct to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be part of each order which we may hereafter give to you unless otherwise specified and shall be valid until cancelled by us in writing or revoked by the city or state. General description of products to be purchased from the seller Under penalties of perjury I swear or affirm that the information on this form is true and correct as to every material matter. FT DR 0563 2/94 COLORADO DEPARTMENT OF REVENUE 1375 SHERMAN STREET DENVER CO 80261 SALES TAX EXEMPTION CERTIFICATE MULTI-JURISDICTION See reverse side for instructions. Issued to Seller Address Name of Firm Buyer I CERTIFY THAT Street Address or Post Office Box Number City State WHOLESALER QUALIFIES AS Check each applicable item RETAILER LESSOR See note on reverse side MANUFACTURER POLITICAL SUBDIVISION OR GOVERNMENTAL AGENCY ZIP Code CHARITABLE OR RELIGIOUS OTHER Specify and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is of sales or use tax in such states and cities because the buyer is or that such purchases are exempt from payment OTHERWISE EXEMPT BY STATUTE SPECIFY City or State State Registration or ID Number I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax we will pay the tax due direct to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be part of each order which we may hereafter give to you unless otherwise specified and shall be valid until cancelled by us in writing or revoked by the city or state. General description of products to be purchased from the seller Under penalties of perjury I swear or affirm that the information on this form is true and correct as to every material matter. FT DR 0563 2/94 COLORADO DEPARTMENT OF REVENUE 1375 SHERMAN STREET DENVER CO 80261 SALES TAX EXEMPTION CERTIFICATE MULTI-JURISDICTION See reverse side for instructions. Issued to Seller Address Name of Firm Buyer I CERTIFY THAT Street Address or Post Office Box Number City State WHOLESALER QUALIFIES AS Check each applicable item RETAILER LESSOR See note on reverse side MANUFACTURER POLITICAL SUBDIVISION OR GOVERNMENTAL AGENCY ZIP Code CHARITABLE OR RELIGIOUS OTHER Specify and is registered with the below listed states and cities within which your firm would deliver purchases to us which are for resale or lease by us in the normal course of our business which is of sales or use tax in such states and cities because the buyer is or that such purchases are exempt from payment OTHERWISE EXEMPT BY STATUTE SPECIFY City or State State Registration or ID Number I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax we will pay the tax due direct to the proper taxing authority when state law so provides or inform the seller for added tax billing..

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