Firm Name :
I hereby certify that I hold valid seller's permit No. :
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Issued in pursuance of the Sales and Use Tax law, and I am engaged in the business of selling :
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And that tangible personal property described herein, which I shall purchase from Cigma, will be resold by me in the form of tangible personal property. PROVIDED, however that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the price of such property.
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Description of property purchased:
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*Image Text:
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I agree, Submit
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