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The purchaser hereby claims exception or exemption on all purchases of tangible personal property
and selected services made from:
R.L Shane Company
(vendor's name)
 
and certifies that this claim is based upon the purchaser's proposed use of the items or
services, the activity of the purchaser, or both, as shown hereon:
 

PURCHASER MUST STATE A VALID REASON FOR Claiming EXCEPTION FOR EXEMPTION.
 
Purchaser's Name:  
Street Address:  
City:  State:      Zip Code:    
Signature and Title:  
Date Signed:  
MM    DD YY
Vendors License Number, if any:
 
 
Vendors of motor vehicles. titled watercraft and titled outboard motors may use this certificate to purchase these items under the "resale" exception. Otherwise. purchasers must comply with rule 5703-9-10 of the Administrative Code.

This certificate cannot be used by construction contractors to purchase material for incorporation into real property under an exempt construction contract. Construction contractors must comply
with rule 5703-9-14 of the Administrative Code.