ONTARIO RETAIL SALES TAX
PURCHASE EXEMPTION CERTIFICATE

Blanket

BUSINESS NAME: BUSINESS ADDRESS: VENDOR PERMIT NUMBER: (if applicable) NATURE OF BUSINESS: Under the provisions of the Retail Sales Tax Act, the above-named business claims exemption from tax on the following items of langible personal property and on the following taxable services: Signature of Authorized Person Date Name of Authorized Person

IMPORTANT

The person purchasing the tangible personal property or taxable service for which an exemption is claimed must complete this certificate and give it to the supplier. The supplier is to retain this form as provided by the regulations. This purchase exemption certificate is valid for four years for purchases of the above-listed items and services if, ,

• the box beside the word "blanket" at the top of the form is checked; and
• the purchase order refers to this purchase exemption certificate.

Every person who makes a false statement on this certificate or misuses the certificate is liable on conviction to a fine of not less than $500 and not more than $10,000 plus an amount of not more than double the amount of tax that should have been declared to be collectable or payable or that was sought to be evaded, or to imprisonment for a term of not more than two years, or to both.

Ministry Retail of Sales Tax Revenue Branch Ontario