State of ________________Department of Taxation and Finance - Taxpayer Service Division
Blanket Certificate of Exemption
Sales & Use Tax Resale Certificate
To be completed and signed by purchaser.
Issued to : Merrick Tackle Center
7349 Route 28
Shandaken, NY 12480
Phone (845) 688-2216 / Fax (845) 688-2329
I certify that:
Name of Vendor
Street Address
City State Zip
Phone Fax
is engaged as a registered:
Wholesaler Retailer Manufacturer Lessor
Other: _________________________________
and is registered with the below listed state(s) and city(ies) within which your firm would deliver purchases to us and
that any such purchases are for wholesale, retail, ingredients or components of a new product to be resold, leased, or
rented in the normal course of our business. We are in the business of wholesaling, retailing, manufacturing, leasing,
renting the following:
___________________________________ _____________________________________
NYS residents State Tax ID#; all other states require Federal ID#
I further certify that if any property so purchased tax free is used or consumed by the firm as to make it subject to sales
or use tax we will pay the tax due direct to proper taxing authority when state law so provides or inform the seller for
added tax billing. This certificate shall be part of each order which we may hereafter give to you, unless otherwise speci-
fied, and shall be valid until cancelled by us in writing or revoked by the city or state.
General description of products to be purchased from the seller:
I declare under the penalties of false statement that this certificate has been examined by me and
to the best of my knowledge and belief is true, correct and complete.
Authorized Signature:__________________________________________________
(Owner, Partner or Corporate Officer)
Title:_______________________________ Date:_________________
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