Application Sales Tax Exemption

Sales Tax Exemption Certificate

Owner

Name:	Email:
Phone:	Cell Phone:
Address:	City:
States	Zip Code:

Contractor

Name:	Email:
Phone:	Cell Phone:

Project

Address:	City:
States	Zip Code:

Project Description:

Estimated Value:

Authorization By Town

Authorized Signature Town of De Beque:

Good For 180 Days Through:

This certificate is to serve as proof that the above owner/contractor has a construction project in the Town of De Beque, Colorado, and has paid a 2% use tax to the Town. For verification please contact Shirley Nichols, Town Clerk, or Diane Rickstrew, Deputy Clerk, 970-283-5475 x 101.
Note to Supplier: Keep this form for your records

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Application Sales Tax Exemption

Sales Tax Exemption Certificate

TOWN HALL

ADDRESS

WELCOME