The purchaser hereby claims exception or exemption on all purchases of tangible personal property and selected services made under this certificate from:

Country Manufacturing, Inc.

and certifies that the claim is based upon the purchaser's proposed use of the items or services, the activity of the purchaser, or both as shown hereon:

* Please State Reason for Exception or Exemption

Purchaser Must State A Valid Reason For Claiming Exception or Exemption


* Fields Are Required

Purchaser's Name *
Street Address *
City *
State *
Zip Code *
Signature and Title (Typing Your Name In This Field Is A Valid Digital Signature) *
Date Signed *
Vendor's 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.