Form Cert-121 - Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits Certificate Template - Department Of Revenue Services, Connecticut Page 2

Download a blank fillable Form Cert-121 - Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits Certificate Template - Department Of Revenue Services, Connecticut in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Cert-121 - Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits Certificate Template - Department Of Revenue Services, Connecticut with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Name of Purchaser
Address
Social Security Number
Name of Seller
Address
CT Tax Registration Number
Federal Employer ID Number
(If None, explain)
Check One Box
Blanket Certificate
Certificate for One Purchase Only
Description of Services Purchased
Declaration by Purchaser
I am eligible for and am currently receiving total disability benefits under the Social Security Act. The services described on this certificate
are landscaping and horticulture services, window cleaning services, or maintenance services to be provided at my residence, as
described in Conn. Gen. Stat. §12-412(85).
In accordance with Conn. Gen. Stat. §12-412(85), the purchase of these services is not subject to sales and use taxes.
I declare under penalty of law that I have examined the information in this certificate and to the best of my knowledge and belief it is true,
complete, and correct. I understand the penalty for willfully delivering a false return to DRS is a fine of not more than $5,000, or
imprisonment for not more than five years, or both.
By:
Name of Purchaser
Signature
Date
CERT-121 (Back)
(Revised 07/03)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Cert-121 - Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits Form Cert-121 - Exemption For Landscaping And Horticulture Services, Window Cleaning Services, And Maintenance Services Provided To Recipients Of Total Disability Benefits Financial
Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry - Connecticut Department Of Revenue Services Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry - Connecticut Department Of Revenue Services Financial
Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry - Connecticut Department Of Revenue - 1997 Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry - Connecticut Department Of Revenue - 1997 Financial
Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solis Waste-to-energy Facilities Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solis Waste-to-energy Facilities Financial
Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Financial
Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities - 1998 Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities - 1998 Legal
Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Financial
Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Form Cert-131 - Exemption For Projects Of The Connecticut Resources Recovery Authority And Solid Waste-to-energy Facilities Financial
Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry Form Cert-129 - Exemption For Items Used Directly In The Biotechnology Industry Financial
Form Cert -129 - Exemption For Items Used Directly In The Biotechnology Industry Form Cert -129 - Exemption For Items Used Directly In The Biotechnology Industry Financial

Related Categories

Parent category: Business
Download
Go
Page of 2