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STATE OF OHIO
DEPARTMENT OF TAXATION
68 EAST GAY STREET, COLUMBUS, OHIO
BLANK CERTIFICATE OF EXEMPTION

The undersigned hereby claims exemption to purchases of tangible personal property from:

LEFELD WELDING &STEEL SUPPLIES,INC.
DBA: LEFELD INDUSTRIAL & WELDING SUPPLIES

On and after (date) ___*enter date below*___ and certifies that this claim is based upon the purchaser proposed use of the items or services purchased, the activity of the purchaser, or both, as shown hereon:

Date*

Section I

For purchase of certain safety related items which are not attached to or part of exempt machinery and equipment. Per Tax Law Effective 7/1/90 (Check one Below)*

Yes, exempt
No, Not Exempt

If check yes state reason

Section II

For purchase of compressed gas cylinder rent or demurrage charges (Check one below)*

Yes, exempt
No, Not Exempt

If check yes state reason

Section III

For purchase of renting tools, equipment and related accessories (Check one below)*

Yes, exempt
No, Not Exempt

If check yes state reason

Section IV

For all other purchases other than those stated above in Sections I, II, or III (Check one below)*

Yes, exempt
No, Not Exempt

If check yes state reason

This certificate shall continue in force until revoked and shall be considered apart of each order given to the above named vendors unless the order specified otherwise.

Purchaser’s Name or Firm*

By-Signature*

Purchaser's Title*

Date Signed*

Purchaser's Address*

Street Address City State ZIP Code

Purchaser’s Type Business Activity*

Vendor’s License NO. (If Any)

View tax exempt reasons and classifications here.

Phone

This field is for validation purposes and should be left unchanged.

Tax Exempt Form

Section I

Section II

Section III

Section IV