DECLARATION
I HEREBY CERTIFY THAT:
___________________________
___________________________
Street, City, State, Zip Code: ___________________________
I understand that this declaration is for the purpose of allowing the above named seller to treat the sale of the above-described tangible personal property as exempt from the use tax imposed by the (name of district) District. If the property is principally stored, used or otherwise consumed in that district, the purchaser shall be liable for and pay the use tax.
I have personal knowledge of the statements of fact contained in this declaration. I declare under penalty of perjury under the laws of the State of California and the United States that the foregoing statements are true and correct.
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Name of Purchaser
___________________________
Name and Title of Authorized Agent
(if applicable)
___________________________
Signature of Purchaser or Authorized Agent
______________________________
Date
Cal. Code Regs. Tit. 18, § 1823.4
Note: Authority cited: Section 7051, Revenue and Taxation Code. Reference: Sections 7261 and 7262, Revenue and Taxation Code.