K E N A I  P E N I N S U L A  B O R O U G H
                                                          
                                        144 N. BINKLEY · SOLDOTNA, ALASKA 99669-7520
      21664                              PHONE (907) 714-2175 WEB SITE: http://www.kpb.us

                                        APPLICATION FOR RESALE CERTIFICATE

       Business MUST be registered for sales tax collection in order to receive a Resale Certificate.
       Resale Certificates are processed each Thursday.  Applications received after 12:00 P.M. on Tuesday 
        will not be processed until the following week.
       Original application must be submitted. Cost per Resale Certificate is $10.00 per certificate issued.
       Resale Certificates will NOT be issued if account is not in compliance with KPB Code 5.18.
       ORIGINAL RESALE CERTIFICATE MUST BE PRESENTED TO THE SELLER AT THE TIME OF 
        PURCHASE IN ORDER TO RECEIVE THE EXEMPTION, NO COPIES.
SECTION 1: Current business information.
This is a            NEW RENEWAL        REISSUE          Application for January 1 through December 31,
  Check this box if the information below is NOT correct.  Please correct where necessary.
Account #:                              Business Name:
Mailing Address:                                                                               Phone #:
City:                                                                 State:                   Zip:
Business activity:

SECTION 2: Name of person(s) who will carry Resale Certificate(s).
                     One letter per box                                                                      $10.00 Each
1                                                                                                             $10.00

2                                                                                                             $10.00

3                                                                                                             $10.00

4                                                                                                             $10.00

5                                                                                                             $10.00

SECTION 3: Items to be purchased for resale.                                                          SUPPLEMENTAL
      Code                                      Describe Items to be Purchased for Resale
1
2
3
4

                     RESALE CERTIFICATES EXPIRE ANNUALLY ON DECEMBER 31st
I declare subject to the penalties prescribed in Kenai                FOR OFFICE USE ONLY
Peninsula Borough ordinances that this application has
been examined by me and to the best of my                 Cash                               ,        ,      .
knowledge and belief is a true and complete
                                                          CK#
application.  I acknowledge that I am solely responsible                                     ,        ,      .
for purchasing within the categories listed, and I am     CK#
responsible for any sales tax liability resulting from                                       ,        ,      .
misuse of the Resale Certificate.  I understand that      E-Check
                                                                                             ,        ,      .
misuse of the Resale Certificate is unlawful and
subject to prosecution and fine.                          Credit Card                        ,        ,      .
                                                                  Total Remitted             ,        ,      .

                     Owner Signature                                                     Date