(For use by States and Local Governments (section 4221 (a) (4) of the Internal
Revenue Code.)
________________, 19____
I, hereby certify that I am _____________________of ________________________
(Title of Officer) (State or Local Government)
That I am authorized to execute this certificate; and that (check applicable type of certificate)
____________The article or articles specified in the accompanying order, or
on the
reverse side hereof,
(OR)
____________All orders placed by the purchaser for the period commencing ________
And ending __________ (period not to exceed 12 calendar
Quarters), are or will be purchased from Combined Tactical Systems,
Inc. for the exclusive use of _________________ of ________________
(Government Unit) (State or 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)
___________________________
(Address)
Return To: Gulf States Distributors
6000 E. Shirley Lane
Montgomery, AL 36117