Form 5000A Fillable Arizona Resale Certificate
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

5 Check Applicable Box: Single Purchase Certificate Period: Through I certify if purchasing as an agent or officer (checkbox) Unchecked (text) (text) (text) (text) (text) (text) (text) (text) 1 Purchaser: 127 B 2 127 B 2 127 B 2 2 I am engaged in the business of: 3 The property is purchased for resale and will be resold in the ordinary course of business 4 Description of the property being purchased ADOR 60 2018 (8/02) Arizona ARIZONA FORM ARS 42 1 ARS 42 1ARS 42 1 cate on behalf of the purchaser named above cate on behalf of the purchaser named above cate on behalf of the purchaser named above cercer CERTIFICA CERTIFICACERTIFICA City State Zip Code: DateDate exemption exemption FurtherFurther I (print full name) hereby certify that these purchases are for resale andI (print full name) hereby certify that these purchases are for resale and illful misuse of this Certificate will subject the License number: may be required to establish the accuracy of the claimed exemption as provided in ARS 42 5022 may be required to establish the accuracy of the claimed exemption as provided in ARS 42 5022 Subsequent not accept the certificate in good faith and the seller will not be relieved of the burden of proving entitlement to thenot accept the certificate in good faith and the seller will not be relieved of the burden of proving entitlement to the of business will subject the purchaser to the Arizona use tax illful misuse of this Certificate will subject theof business will subject the purchaser to the Arizona use tax W PURCHASER INFORMA PURCHASER INFORMAPURCHASER INFORMA purchaser to criminal penalties of a felony pursuant to purchaser to criminal penalties of a felony pursuant topurchaser to criminal penalties of a felony pursuant to Resale Certificate 5000A SELLER INFORMA SELLER INFORMASELLER INFORMA seller that accepts a certificate in good faith will be relieved of the burden of proof and the purchaser seller that accepts a certificate in good faith will be relieved of the burden of proof and the purchaserexemption seller that has reason to believe that the certificate is not accurate complete or applicable to the transaction may seller that has reason to believe that the certificate is not accurate complete or applicable to the transaction mayA Seller: Signature of purchaser Signature of purchaserSignature of purchaser Street Address: SubsequentSubsequent that I am authorized to execute this Certifi that I am authorized to execute this Certifithat I am authorized to execute this Certifi that the information on this Certificate is true accurate and complete if purchasing as an agent or offi I certifythat the information on this Certificate is true accurate and complete Further This Certificate is to be completed by the purchaser and furnished to the vendor who shall retain it Incomplete certificates must not be accepted in good faith TIONTION TIONTION TitleTitle use or consumption of the tangible personal property by the purchaser other than the sale in the ordinary courseuse or consumption of the tangible personal property by the purchaser other than the sale in the ordinary course