Form Boe-231 - Application For Section 6377 - Manufacturer'S Exemption Certificate And Use Tax Declaration - 1997 Page 2

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BOE-231 (BACK) REV. 2 (8-97)
SECTION IV — MISCELLANEOUS INFORMATION
ARE YOU
Starting a new business?
Incorporating an existing sole proprietorship or partnership?
Other?
Buying a business?
If yes, please indicate name of former owner and account number:
FORMER OWNER
ACCOUNT NUMBER
PURCHASE PRICE
VALUE OF FIXTURES AND EQUIPMENT
$
$
SECTION V — CERTIFICATION
The statements above are hereby certified to be correct to the best knowledge and belief of the
undersigned, who is duly authorized to sign this application.
SIGNATURE
TITLE
(Typed or Printed)
NAME
DATE
FOR BOARD USE ONLY
SALES/USE TAX PERMIT NUMBER
APPROVED
YES
NO
VALID
FROM
TO
MANUFACTURER’S EXEMPTION CERTIFICATE NUMBER
MANUFACTURER’S USE TAX DECLARATION NUMBER
REVIEWED BY
APPROVED BY
DISAPPROVAL REASONS:
Incomplete Information
SIC Code Not Appropriate
Start of Business/Activity Prior to 1/1/94
No Seller’s Permit or Consumer Use Tax Account
Agent Status Only
Other
Attach Additional Sheets as Necessary

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