Sales and Use Tax Exemptions and Requirements
Page 5 of 5
Non-Profit Organizations
____Government Entity, Nonprofit School, Nonprofit Hospital, and Church
(circle type of organization)
____Internal Revenue Code Section 501(c)(3) and 501(c)(4) Organizations
____Exempt letter from the State of Michigan
____Other (explain):_______________________________________________
Section 4: Certification:
In the event this claim is disallowed, the purchaser promises to reimburse the seller for the amount of tax involved.
Purchaser _____________________________________
Street Address____________________________________________________
Area Code / Telephone No. _____________________________________
City State Zip Code _____________________________________________________
Signature and Title Date Signed ___________________________________________________________
Name (Print or Type) _________________________________________________________
1A blanket certificate is valid for three years from date of signature unless an earlier expiration date is listed below:
Expiration date, if less than three years: _______________ .
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3/3/00