TEXAS SALES TAX EXEMPTION CERTIFICATE

Name of purchaser, firm or agency
Address (Street & number, P.O. Box or Route number)	Phone (Area code and number)
City, state, ZIP code

I, the purchaser named above, claim an exemption from payment of sales taxes for the purchase of taxable items described below or on the attached order or invoice from: Seller: Cherokee County Electric Cooperative Assn. Street Address: Hwy 69 N. City, State, ZIP code: Rusk, TX 75785
Description of items to be purchased, or on the attached order or invoice: ___Electricity_______________________________________________________________________ __________________________________________________________________________________ Purchaser claims this exemption for the following reason: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ I understand that I will be liable for payment of sales tax which may become due for failure to comply with the provisions of the state, city, and metropolitan transit authority, city transit department and/or county sales and use tax laws and Comptroller rules regarding exempt purchases. Liability for the tax will be determined by the price paid for the taxable items purchased or the fair market rental value for the period of time used. I understand that it is a misdemeanor to give an exemption certificate to the seller for taxable items which I know, at the time of purchase, will be used in a manner other than that expressed in this certificate and that upon conviction may be fined no more that $500 per offense.
Purchaser Sign Here>	Title	Date