Form 604-Certificate Of Exemrtion
ADVERTISEMENT
1
2604
T
N
N
FORM
HE
AVAJO
ATION
S
T
ALES
AX
C
O
E
ERTIFICATE
F
XEMPTION
1041
O
N
.
CAUTION: An Issuer who misuses this certificate may be subject to suspension of the right to use certificate of exemptions
THE GENERAL CONTRACTOR NAMED BELOW HAS BEEN APPROVED AS ELGIBLE TO ISSUE CERTIFICATES OF
EXEMPTION FOR THE TRANSACTION STATED BELOW AND MORE SPECIFICALLY DESCRIBED IN THE SALES TAX ACT
CONSTRUCTION CONTRACTOR
The general contractor delivering the certificate of exemption must have the construction
Purchase of Construction Services
services (subcontracts) performed upon or materials used in a construction project which is
or Materials
subject to the Sales Tax.
TO WHOM ISSUED:
NAME OF GENERAL CONTRACTOR:
STREET OR MAILING ADDRESS:
STREET OR MAILING ADDRESS:
CITY, STATE, ZIP CODE:
CITY, STATE, ZIP CODE:
AUTHORIZED SIGNATURE:
DATE:
Office of the Navajo Tax Commission
X
TITLE:
Post Office Box 1903, Window Rock, Arizona 86515
Phone: (928) 871-6681; Fax: (928) 871-7608
THIS CERTIFICATE MAY NOT BE DUPLICATED
604
T
N
N
FORM
HE
AVAJO
ATION
S
T
ALES
AX
C
O
E
ERTIFICATE
F
XEMPTION
1042
O
N
.
CAUTION: An Issuer who misuses this certificate may be subject to suspension of the right to use certificate of exemptions
THE GENERAL CONTRACTOR NAMED BELOW HAS BEEN APPROVED AS ELGIBLE TO ISSUE CERTIFICATES OF
EXEMPTION FOR THE TRANSACTION STATED BELOW AND MORE SPECIFICALLY DESCRIBED IN THE SALES TAX ACT
CONSTRUCTION CONTRACTOR
The general contractor delivering the certificate of exemption must have the construction
Purchase of Construction Services
services (subcontracts) performed upon or materials used in a construction project which is
or Materials
subject to the Sales Tax.
TO WHOM ISSUED:
NAME OF GENERAL CONTRACTOR:
STREET OR MAILING ADDRESS:
STREET OR MAILING ADDRESS:
CITY, STATE, ZIP CODE:
CITY, STATE, ZIP CODE:
AUTHORIZED SIGNATURE:
DATE:
Office of the Navajo Tax Commission
X
Post Office Box 1903, Window Rock, Arizona 86515
Phone: (928) 871-6681; Fax: (928) 871-7608
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