HomeMy WebLinkAboutCORRESPONDENCE - GENERAL CORRESPONDENCE - 3304902 TAX EXEMPTION CERTIFICATECity of Fort Collins
Administrative Services
Finance Department - Accounting Division
BLANKET EXEMPTION CERTIFICATE
(For use by States, Territories, or political subdivision thereof)
Date: August 12, 2003
The undersigned hereby certifies that she is Alicia Miodonski, A/P Representative
of the City of Fort Collins authorized to execute this certificate and that the article or
articles specified in the accompanying orders, or on the reverse side hereof, are purchased
from THE SUPPLY CACHE INC for the exclusive use of
the City of Fort Collins of the State of Colorado.
It is understood that the exemption from tax in the case of sales of articles under this
exemption certificate to a State, etc., is limited to the sale of articles purchased for its
exclusive use, and it is agreed that if articles purchased tax free under this exemption
certificate are used otherwise or are sold to employees or others, such fact will be
reported by me to the manufacturer of the article or articles covered by this certificate. It
is also understood that the fraudulent use of this certificate to secure exemption will
subject the undersigned and all guilty parties to a fine of not more than $10,000.00 or to
imprisonment for not more than five years, or both, together with costs of prosecution.
State of Colorado Department of Revenue, Certificate of Exemption
Identification Number 98-04502.
(Signature)
A/P Representative
(Title of Officer)
215 North Mason Street • 2nd Floor • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6770 • FAX (970) 221-6782