SAMPLE LETTER
Federal Cartridge Co
Federal Excise Tax Exemption Certification
(For use by States and local governments (section
4221(a)(4) of the Internal Revenue Code).
Date_______________________,
2___________
I, hereby certify that I
am_____________________________________(title)
of
_________________________________,(state or local government) and
that I am authorized to execute this
certificate and that all orders placed by the
purchaser for the period commencing_______________________(*date)
and
ending
_____________________(*date)(period not to exceed 12 calendar
quarters), are, or will be, purchased
from Federal Cartridge/Gulf States
Distributors for the exclusive use of
_________________________________
(government unit) of _________(state
of local government).
I understand that the exemption from
tax in the case of sales of articles under this exemption certificate to a
State, etc., is limited to the sale of articles purchased for its exclusive
use. I understand that fraudulent use of this certificate for the purpose of
securing this exemption will subject me and all parties making such fraudulent
use of this certificate to all applicable criminal penalties under the Internal
Revenue Code.
Signature__________________________
Shipping Address ________________________________
________________________________
*Certificate Valid for Three Years
DO
NOT FAX-MUST HAVE ORIGINAL SIGNATURE.
Return
form via mail with original signatures to:
Gulf States Distributors
6000 E Shirley Lane
Montgomery AL 36117