Tennessee Exemption Certificate – Fill Out and Use

N0003101

7632128070716

TENNESSEE DEPARTMENT OF REVENUE

Certificate of Exemption

Under the provisions of T.CA Section 67-6-322, the organization named above is granted authority from the Tennessee Department of Revenue to make purchases, without payment of the Sales or Use Tax, of tangible personal property or taxable services to be used or consumed by the organization itself or to be given away.

The organization must furnish the suppliers of goods and services with a COPY of this exemption certificate. The lower portion of the certificate must be properly completed. The organization MUST retain the original certificate for copy purposes. The supplier will maintain a file copy as evidence of exemption. Later purchases do not require the submission of additional copies. Invoices must contain the name of the organization and the number given above.

This authority does not extend to purchases made by representatives of the. organization when the items purchased or services rendered are paid for with personal funds. It does not extend to items purchased to be resold.

THE ORGANIZATION MUST NOTIFY THE DEPARTMENT IMMEDIATELY IF IT CEASES TO EXIST, MOVES, OR IN ANY WAY CHANGES THE ORGANIZATION FROM ITS PRESENT FORM.

	Reagan	Farr
EFFECTIVE DATE July 1, 2007	COMMISSIONER	OF REVENUE

TO BE COMPLETED BY THE ORGANIZATION (please print)

TO: SUPPLIER'S NAME				_
ADDRESS				_
CITY	STATE	_	ZIP	_
I	as	an	authorized	representative of the organization named

above affirm that the purchases made under this authority will be used and consumed by the organization or will be given away. I further affirm that the organization will not use this authority to purchase items for resale.

Under penalty of perjury, I affirm this to be a true and correct statement.

PRINT	NAME OF ORGANIZATION:	_
PRINT	NAME OF PURCHASER:
SIGNATURE OF PURCHASER:		_

RV·N0003101

For additional information or assIstance regarding this notice, you should contact the Department of Revenue. Tennessee residents may use the toll-free

number, 1-800-342-1003. Nashville area and out-of-state callers may call (615)253-0600. Hearing Impaired may call TDD at (615)741-7398. You may call either of these numbers between 8:00 a.m. and 4:30 p.m. (CT), Monday through Friday, holidays excepted. You may direct any correspondence or submit

written information to the following address: Tennessee Department of Revenue, 500 Deaderick Street, Nashville, TN 37242. Please provide your account number and notice number when inquiring about the notice.