Figure: 34 TAC §3.319(f)

Prior Contract Exemption Certificate

This certificate is issued to _____________________________ and is intended to be applicable to the
following taxes (check appropriate space)

                State __            City __              MTA __             County __

Taxpayer's Name                                                                                     Identification Number

Project Idenfication, where appropriate.                             Date of Execution


Description of Taxable Item Purchased _________________________________________________

I hereby claim an exemption from the payment of the sales and use tax indicated at the beginning of
the form on the basis that I have complied or shall comply with the provisions of the appropriate
tax code, relateing to written contracts or bids executed prior to the effective date of the tax or a tax
rate change.

I will be liable for payment of the sales and use tax if I use the taxable item in some other manner
or for some other purpose than the reason stated above and shall pay the tax based on the price paid
for the taxable item.

Taxpayer's Name:  _______________________________________

Taxpayer's Address:  _____________________________________


Signature of Authorized Agent:  ______________________________

Date Issued:  ____________________________________________

Printed Name of Authorized Agent:  ___________________________

Telephone Number:  _______________________________________