P.O. Box 801309
Dallas, TX 75380
(800) 950-6611 phone
(800) 456-5959 fax
customeraccounts@statononline.com
SALES TAX EXEMPTION FORM
UPDATE
DATE
Company Name Street Address
City/State/Zip
Phone Fax
Email
COMPANY OWNER/PRESIDENT INFORMATION:
1) Name Title
Home Address City/State/Zip
Home Phone Cell Phone
2) Name Title
Home Address City/State/Zip
Home Phone Cell Phone
SALES TAX INFORMATION
The undersigned certifies that all products purchased from Staton Holdings, Inc. are tangible personal property which is exempt from
sales and use tax for the following reason:
Sales & Use Tax Permit Or Registration Number
Effective Date Expiration Date
(if applicable) (if applicable)
If the laws of the governing state so requires, all items purchased for resale will be resold by me within the geographical limits of the
US, it’s territories and possessions, or within the geographical limits of the United Mexican States, in their present form or attached
to other taxable items to be sold. I understand that it is unlawful to give a resale certificate to a seller for taxable items which I
know at the time of purchase will be used in a manner inconsistent with the purpose stated in this certificate. I am aware that it is
unlawful to present a resale certificate for the purchase of taxable items in which are intended for my use, or for any use other than
retention, demonstration, or display while holding them for sale. I recognize that if I make any other use of such items, I must pay
sales tax on the items at the time of use, based on the purchase price. I acknowledge that the misuse of this certificate may subject
me to sanctions and penalties as prescribed by laws of the governing state. For Texas purchasers, I understand that it is a criminal
offense to give a resale certificate to the seller for taxable items that I know, at the time of purchase, are purchased for use rather
than for the purpose of resale, lease, or rental and depending on the amount of tax evaded, the offense may range from a Class C
misdemeanor to a felony of the second degree. I further understand that if any goods purchased pursuant to the completion of this
certificate are determined to be subject to sales or use tax, such tax will be borne by me as purchaser. This certificate continues in
force until revoked by written notice to Staton Holdings, Inc. and the Department of Revenue of the governing state.
NEW
PRODUCT FOR RESALE EXEMPT EXPORT INCORPORATED IN A PRODUCT FOR RESALE
The vendor (Staton Holdings, Inc.) must know, within the use of ordinary care, that the merchandise obtained upon this certificate of
resale is merchandise normally sold by the vendee (our customer) in his or her usual course of business. Vendors failing to exercise
such care will be liable for the sales tax due upon such purchases.
Usual Business Activity Description Of Items To Be Purchased
Name Of Company Representative (Please Print) Authorized Signature
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