Ohio Tax Exemption Form

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Sales and Use Tax Blanket Exemption Certificate

The purchaser hereby claims exception or exemption on all purchases of tangible personal property and selected services made under this certificate form.

Powers Oil Ltd. dab Powers Oil and Propane 1681 W. Main St. Alliance, Ohio 44601

and certifies that the claim is based upon the purchaser's proposed use of the items or services, the activity of the purchase, or both, as shown hereon:

Purchaser must state a valid reason for claiming exception or exemption.(Required)

Purchaser Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Signature(Required)

Title(Required)

Date(Required)

Vendor License (If Any)(Required)

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