Only for public school and government agencies
In order to sell the arrows for $147, we must have this form filled out. Federal Excise Tax is a tax the
arrow manufacturer pays unless they sell to a public school/government.
THIS IS NOT THE SAME AS SALES AND USE TAX!
Federal Excise Tax on Archery Equipment
EXEMPTION CERTIFICATE
For use by states, local governments and public schools in the US
Section 4221(a)(4) of the Internal Revenue Code
________________________________, 20____
Date
I hereby certify that I am ___________________________________________________
(Title of Individual)
of_____________________________________________________________________,
(State, local government or school)
(Employer Identification Number)
that I am authorized to execute this certificate;
and that all orders placed by our school or government agency
for the period commencing _______________ and ending _______________
(period not to exceed 3 years),
are purchased from NASP, Inc. for the exclusive use of
_____________________________of __________________________.
(Government agency or public school)
(State or local government)
I understand that the exemption from tax in the case of sales of articles under this exemption certificate
to a government agency or public school is limited to the sale of articles purchased for exclusive use by
the government agency or school.
I understand that the fraudulent use of this certificate for the purpose of securing this exemption will
subject me and all parties making such fraudulent use of this certificate to a fine of not more than
$10,000, or to imprisonment for not more than five years, or both, together with costs of prosecution.
_____________________________________________________
Signature of Authorized Individual
_____________________________________________________
Title
_____________________________________________________
_____________________________________________________
Address
Please return by mail or fax to:
NASP, Inc.
W4285 Lake Drive
Waldo, WI 53093
Phone (920) 523-6040
Fax (920) 523-6042
michelleh@nasparchery.com