Department of the Treasury

Bureau of Alcohol, Tobacco and Firearms

EXEMPTION CERTIFICATE

(For use by States and Local Governments (Section 4221(a)(4) of the Internal Revenue Code).)

(Date)_______________________________________

I hereby certify that I am ____________________________________________

(Title of Officer)

of _________________________________: That I am authorized to execute this certificate; and that

(State or Local Government)

(check applicable type of certificate):

____ The article or articles specified in the accompanying order, or on the reverse side hereof, (or)

Are, or will be, purchased from __________________________________________ for the

Exclusive use of ________________________________________________________

(Government Unit)

of _______________________________________________________ .

(State or Local Government)

I understand that the exemption from tax in the case of sales of articles under this exemption certificate to a

State, etc., is limited to the sale of articles purchased for its exclusive use. I understand that fraudulent use

of this certificate for the purpose of securing this exemption will subject me and all parties making such fraudulent use of this certificate to all applicable criminal penalties under the Internal Revenue Code.

 

SIGNATURE

ADDRESS

 

ATFI 5600.35 (2-94)

A sale of an article to a State or Local Government for resale is not considered to be a sale for the "exclusive

use" of the State or Local Government, within the meaning of Section 4221 (a)(4) of the Code, and, therefore,

such sales may not be made tax-free. Such sales may not be made tax-free even if the resale are made to government employees, or articles is an item of equipment the employee is required to possess in carrying

out his duties.

* Must be executed and signed by an officer or employee **Completed form to be returned to:

Authorized by the State or Local Government to execute Parro's Gun Shop & Police Supplies Inc

And sign the certificate. 95 US RT 2, Waterbury, VT 05676