Reseller Information

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

Please complete the form below

Company Name

Seller’s Permit Number

I am engaged in the business of selling the following type of tangible personal property

This certificate is for the purchase from Park 1039 of the item(s) I have listed below.

Description of property to be purchased for resale

I have read and understand the following: For Your Information: A person may be guilty of a misdemeanor under Revenue and Taxation Code section 6094.5 if the purchaser knows at the time of purchase that he or she will not resell the purchased item prior to any use (other than retention, demonstration, or display while holding it for resale) and he or she furnishes a resale certificate to avoid payment to the seller of an amount as tax. Additionally, a person misusing a resale certificate for personal gain or to evade the payment of tax is liable, for each purchase, for the tax that would have been due, plus a penalty of 10 percent of the tax or $500, whichever is more.

I will resell the item(s) listed above, which I am purchasing under this resale certificate in the form of tangible personal property in the regular course of my business operations, and I will do so prior to making any use of the item(s) other than demonstration and display while holding the item(s) for sale in the regular course of my business. I understand that if I use the item(s) purchased under this certificate in any manner other than as just described, I will owe use tax based on each item’s purchase price or as otherwise provided by law.

Date

YYYY

Name of Purchaser

First Name

Last Name

Phone

(###)

###

####

Address of Business

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

E-Signature of Purchaser

By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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