Figure: 34 TAC §3.288(k)

Direct payment authorization number: ________________________________________

The undersigned hereby claims exemption from the payment of state, city, county, MTA, and/or CTD sales and use taxes upon its purchases of taxable items from:

Seller: ________________________________________

Street address: _________________________________

City, state, zip code: ____________________________

This certificate will remain in effect until the seller is otherwise notified.

Description of items purchased. If this space is left blank, this certificate covers everything on the attached order, invoice, or billing.

______________________________________________________________________________________________

______________________________________________________________________________________________

This certificate does not cover:

(1) Purchases of taxable items to be resold.

(2) Sales or rentals to any purchaser other than the permit holder.

(3) Sales or rentals of motor vehicles subject to the motor vehicle sales and use tax (Chapter 152) and interstate motor carrier sales and use tax (Chapter 157).

(4) Materials or supplies used, transferred, or consumed by a provider of a nontaxable service.

The permit holder agrees not to permit others (including its contractors and repairmen) to use the undersigned's direct payment authorization to purchase materials tax-free. This certificate is not valid for lump-sum new construction projects to improve real property.

The undersigned agrees to accrue and pay the tax to the Comptroller of Public Accounts as required by statute.

Permit holder: _____________________________

Authorized signature: _______________________

Date of purchase: __________________________