STATE OF NEW YORK
For use only by Employees of the State of New York
or its political subdivisions.
AC 946 (Rev. 3/99)
............................................................................................................................................................................ Date ................................
Name of Person or Firm Furnishing Services and/or Materials
.....................................................................................................................................................................................................................
Address
This is to certify that I am an employee of the State of New York or one of its political subdivisions; that the services or materials purchased on the
date set forth below will be paid for by the State or a political subdivision; and that such charges are incurred in the performance of my ofcial duties.
Nature of Transactions __________________________________________________________
Dates of Transactions __________________________________________________________
State Dept., Agency or
Political Subdivision ____________________________________________________________
NOTE: A separate exemption certicate is required from each person claiming exemption.
TO BE RETAINED BY VENDOR AS
EVIDENCE OF EXEMPT SALE
TAX EXEMPTION CERTIFICATE
...............................................................................
Signature of Employee
...............................................................................
Title
STATE OF NEW YORK
For use only by Employees of the State of New York
or its political subdivisions.
AC 946 (Rev. 3/99)
............................................................................................................................................................................ Date ................................
Name of Person or Firm Furnishing Services and/or Materials
.....................................................................................................................................................................................................................
Address
This is to certify that I am an employee of the State of New York or one of its political subdivisions; that the services or materials purchased on the
date set forth below will be paid for by the State or a political subdivision; and that such charges are incurred in the performance of my ofcial duties.
Nature of Transactions __________________________________________________________
Dates of Transactions __________________________________________________________
State Dept., Agency or
Political Subdivision ____________________________________________________________
NOTE: A separate exemption certicate is required from each person claiming exemption.
TO BE RETAINED BY VENDOR AS
EVIDENCE OF EXEMPT SALE
TAX EXEMPTION CERTIFICATE
...............................................................................
Signature of Employee
...............................................................................
Title
STATE OF NEW YORK
For use only by Employees of the State of New York
or its political subdivisions.
AC 946 (Rev. 3/99)
............................................................................................................................................................................ Date ................................
Name of Person or Firm Furnishing Services and/or Materials
.....................................................................................................................................................................................................................
Address
This is to certify that I am an employee of the State of New York or one of its political subdivisions; that the services or materials purchased on the
date set forth below will be paid for by the State or a political subdivision; and that such charges are incurred in the performance of my ofcial duties.
Nature of Transactions __________________________________________________________
Dates of Transactions __________________________________________________________
State Dept., Agency or
Political Subdivision ____________________________________________________________
NOTE: A separate exemption certicate is required from each person claiming exemption.
TO BE RETAINED BY VENDOR AS
EVIDENCE OF EXEMPT SALE
TAX EXEMPTION CERTIFICATE
...............................................................................
Signature of Employee
...............................................................................
Title