PENNSYLVANIA EXEMPTION CERTIFICATE CHECK ONE: [ ] STATE OR LOCAL SALES AND USE TAX [ ] STATE OR LOCAL HOTEL OCCUPANCY TAX [ ] PUBLIC TRANSPORTION ASSISTANCE TAXES AND FEES (PTA) [ ] PASSENGER CAR RENTAL TAX (PCRT) _______________________________________________________________________________ THIS FORM MAY BE PHOTOCOPIED - VOID UNLESS COMPLETE INFORMATION IS SUPPLIED CHECK ONE:      [ ] PENNSYLVANIA TAX UNIT EXEMPTION CERTIFICATE (USE FOR ONE TRANSACTION) [ ] PENNSYLVANIA TAX BLANKET EXEMPTION CERTIFICATE (USE FOR MULTIPLE TRANSACTIONS) Hauser Enterprises___ Name of Seller or Lessor 8 Oak Lane Strasburg, PA 17579-9737 Street City State Zip Code _________________________________________________________________________________________________________ Property and services purchased or leased using this certificate are exempt from tax because: (Select the appropriate paragraph, check the corresponding block below and insert information requested.) [ ] 1. Property or services will be used directly by purchaser in performing purchaser's operation of: _________________________________________________. [ ] 2. Purchaser is a/an: ________________________________________________________________________ [ ] 3. Property will be resold under License Number __________________________. (If purchaser does not have a PA Sales Tax License Number, include a statement under Number 7 explaining why a number is not required.) [ ] 4. Purchaser is a/an: ____________________________ holding Exemption Number ____________________ [ ] 5. Property or services will be used directly by purchaser performing a public utility service. [ ] 6. Exempt wrapping supplies, License Number __________________. (If purchaser does not have a PA Sales Tax License Number, include a state under Number 7 explaining why a number is not required.) [ ] 7. Other _________________________________________________________________________________ (Explain in detail, Additional space on reverse side.) ______________________________________________________________________________________________ I am authorized to execute this Certificate and claim this exemption. Misuse of this Certificate by seller, lessor, buyer, lessee, or their representative is punishable by fine and imprisonment. ______________________________________________________________________________________________ Name of Purchaser or Lessee                Signature                          Date ______________________________________________________________________________________________ Street Address                     City                State                Zip Code 1. ACCEPTANCE AND VALIDTY: For this certificate to be valid, the seller/lessor shall exercise good faith in accepting this certificate, which includes: (1) the certificate shall be completed properly; (2) the certificate shall be in the seller/lessor's possession within sixty days from the date the sale/lease; (3) the certificate does not contain information which is knowingly false; and (4) the property or service is consistent with the exemption to which the customer is entitled. For more information, refer to Exemption Certificates, Title 61 PA Code 32.2. An invalid certificate may subject the seller/lessor to the tax. 2. REPRODUCTION OF FORM: This form may be reproduced but shall contain the same information as appears on this form. 3. RETENTION The seller or lessor must retain this certificate for at least four years from the date of the exempt sale to which the certificate applies. DO NOT RETURN THIS FORM TO THE PA DEPARTMENT OF REVENUE. 4. EXEMPT ORGANIZATIONS: This form may be used in conjunction with form REV-1715, Exempt Organization Declaration of Sales Tax Exemption, when a purchase of $200 or more is made by an organization which is registered with the PA Department of Revenue as an exempt organization. These organizations are assigned an exemption number, beginning with the two digits 75 (example 75-00000-0). This form cannot be used to Obtain a Sales Tax License Number, PTA License Number or Exempt Status.