STATE RESALE TAX I.D. CARD
Please print, fill out the requested information completely and mail along with the
Dealer Application Form to the address above to insure prompt processing of this application.

FIRM NAME ________________________________________________________

I HEREBY CERTIFY,
That I hold valid seller's permit No.__________________________________________
Issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling

_____________________________________________________________________

that the tangible personal property described herein which I shall purchase from GARY STEPHEN GEORGE will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such property.

Description of property to be purchased: FINE ART PRINTS AND/OR ORIGINALS

Dated: _______________________20_______Signature ________________________________

At ___________________________________By and Title_______________________________

Phone_________________________________Address__________________________________

_________________________________                

Dealer Application Form

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