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Get STATE TAX FORM 128-5C

The form under the penalties of perjury has the legal effect of swearing under oath to the truthfulness of the information contained herein: All items on this form must be completed. In addition to other sanctions provided by law, intentional misrepresentation of facts in this application may result in cancellation of this exemption. SUBSCRIBED THIS day of , UNDER THE PENALTIES OF PERJURY Signature of Applicant PHONE.

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