Print this form please and fax it to us at (213) 266-8921.
Company Name (Purchaser)____________________________
I HEREBY CERTIFY: That I hold a valid Seller's Permit No. _________________________ issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling
___________________________________________________________________________; that the tangible personal property described herein which I shall purchase from:
will be resold by me in the form of tangible personal property, provided, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property.
Description of property to be purchased: _________ Silver Jewelry _________
(Print name of Authorized Person/Agent, Title)
Phone ( _____ ) _____________
(Signature of Authorized Person/Agent)