• Blanket Certificate of Exemption from Ohio Sales Tax: 

  Company  name  (required)

  The undersigned hereby claims exemption on purchases of tangible personal property

  from:

  on and after 

  Date

  and certifies that this claim is based upon purchaser's use of the items purchased, the activity of the purchaser, or both 
  as hereon (Check use below)
  
  For resale in the form in which it was received, show vendor's license No. Below:
  
  For use directly in rendition of a public utility service.
  
  For use or consumption directly in the production or tangible personal property for sale by:
       Manufacturing, Processing, Mining, Refining, Farming, Floriculture, Horticulture

  To be incorporated into tangible persona property to be produced for sale by: 
      Manufacturing, Processing, Assembling, Refining
  
  For use or consumption by: 
      A charitable or religious organization, The State of Ohio, A political sub-division of The State of Ohio, The Federal Government

  For use other than above: specify in detail 
  
  
  This certificate shall continue in force until revoked and shall be considered a part of each order given to the above named vendor unless the order specified otherwise. I/we agree that should the personal property purchased under this certificate be determined to be taxable, I/we shall be subjected to the levy provided by the law.

  Purchaser's  Name

  address
  Address (cont.)
  City
  State
  Zip code

  Title
  (If Vendor), license #
  Your Name
  Date

  Purchaser Activity  (i.e. manufacture, Public Utility, church, etc)

  Account Number

  Note: The vendor must support all individual sales made under this certificate by a separate invoice or record, showing description of articke or articles, price for each item, and total amount invoiced in each transaction. The purpose for which 
  or whom, the items were purchased must be written in; other wise this certificate is void.

     

Authorization: 
I understand that I may submit my exemption form to Ullman Oil, Inc. electronically by clicking "Submit Form". If I choose to submit this application electronically, I acknowledge that, regardless of whether I use a web browser with security features, Ullman Oil, Inc. is unable to ensure that the data will not be intercepted by third parties. I agree that Ullman Oil, Inc. is released from any claims and/or liability in the event that the data in this application is intercepted by third parties.

Please make sure you have read the terms and conditions. Do not submit more than one form. Before submitting, please verify all answers are correct.