Tax Exempt – Bogen Concrete Inc.

Sales & Use Tax Certificate of Exemption

Step 1 of 4

This certificate is invalid unless all sections are completed by the purchaser.

Check one of the following:*

One Time Purchase

Blanket Purchase

The purchaser hereby claims exemption on the purchase of tangible personal property and selected services made under this certificate from:

Bogen Concrete, Inc.
26959 Bogen Rd.
Sturgis, MI 49091

And certifies that this claim is based upon the purchaser's proposed use of the items or services, or the status of the purchaser.

Items covered by this certificate:*

All Items Purchased

Limited to the Following Items

List Items to be covered*

Certification

In the event this claim is disallowed, the purchaser promises to reimburse the seller for the amount of the tax involved.

Purchaser/Customer Name*

Signature & Title (Type in Full Name and Title)*

Street Address*

Date Signed*

City, State & Zip Code*

Phone*

Social Security Number*

Confirm Social Security Number

Email*

A blanket certificate is valid for three years from the date of signature.