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Ction was awarded: Day Month Year PART I MERCHANT SELLER'S INFORMATION Seller's name Address Zip Code PART II PURCHASER'S INFORMATION Purchaser's name as it appears on the Merchant's Registration Certificate Merchant's Registration Number Nature of principal business (Description of your commercial activity) Employer Identification Number Describe the tangible personal property that you are purchasing or the service that will be rendered. Date on which the qualified.
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