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Name of Purchaser, Firm or Agency Doing Business As:Street Address City, State, Tithe undersigned represents that he/she is authorized to execute this certificate and hereby claims exemption from
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The form undersigned represents that is a legal document signed by an individual or entity to confirm the accuracy of the information provided.
Any individual or entity who is submitting information that needs to be verified for accuracy may be required to file form undersigned represents that.
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The purpose of form undersigned represents that is to ensure that the information being submitted is accurate and truthful.
The form undersigned represents that typically requires the individual or entity to confirm specific details or statements included in the document being submitted.
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