Abbott's Corporation
Since 1956
33700 Woodward Avenue, Birmingham Michigan 48009-0912
Broker Reporting (1099-B)
We are required to file a form 1099-B with the Internal
Revenue Service for all NON-Corporation transactions on certain reportable items
we purchase (available on request).
We must have written certification that your business is incorporated. (Please
note that a Federal Identification Number (FIN) does not constitute that you are
incorporated.)
Certification of Corporation Status
The undersigned hereby certifies that items being sold to
Abbott's Coinex Corporation are being sold by a
corporate entity.
Corporate Name :
Federal Identification:
President/Officer:
Address:
City:
State:
Zip:
Telephone:
For
NON-Corporation Status
Company Name:
Address:
City:
State:
Zip:
Owner/Individual:
Social Security Number:
Section 1: Mark with an X
One time purchase: [ ]
Blanket Certificate: [ ]
The Purchaser hereby claims exemption on the purchase of
tangible personal property and selected services made under this certificate
from:
Section 2: Items covered by this certificate:
All items purchased: [ ]
Limited to the following items: [ ]
Section 3: Basis for exemption claim:
Resale
[ ] At Retail – Sales Tax Registration Number:
[ ] At Wholesale – No number required
[ ] Agricultural Production: (describe)
[ ] Industrial Processing:
Non- Profit Organizations
[ ] Government Entity
[ ] Non-Profit School
[ ] Non-Profit Hospital
[ ] Church
[ ] Internal Revenue code Section 501 ã(3)
and 501ã(4) Organizations
[ ] Exempt Letter from the State of Michigan
[ ] Other: (explain) :
Section 4: Certification
In the event this claim is disallowed, the purchaser promises
to reimburse seller for the amount of tax
involved.
Purchaser:
Street Address:
Area Code/Telephone Number:
City:
State:
Zip Code:
Signature:
Name and Title :
Date sent:
