INSTRUCTIONS FOR:
THE UNIFORM SALES-USE TAX CERTIFICATE-MULTIJURISDICTION
There are 10 important items which need to be completed:
| Items | Proper Completion of the form | |
| 1. | ISSUED TO SELLER: | A.Y. MCDONALD MFG. CO. |
| 2. | ADDRESS: | P.O. BOX 508 DUBUQUE, IA 52004-0508 |
| 3. | NAME OF FIRM (BUYER): | YOUR FIRM'S NAME |
| 4. | ADDRESS: | YOUR FIRM'S ADDRESS |
| 5. | ENGAGED AS: | YOUR FIRM'S TYPE OF BUSINESS (EXAMPLE: OTHER (SPECIFY): UTILITY, WATER WORKS DISTRIBUTOR) |
| 6. | DESCRIPTION OF BUSINESS: | DESCRIPTION OF YOUR FIRM'S BUSINESS (EXAMPLE: MANUFACTURER OF GAS VALVES). |
| 7. | GENERAL DESCRIPTION OF PROPERTY BEING PURCHASED: | DESCRIPTION OF WHAT YOUR FIRM PURCHASES FROM A.Y. MCDONALD MFG. CO. (EXAMPLE: HIGH PRESSURE GAS VALVES) |
| 8. | PERMIT, STATE REGISTRATION, OR ID NUMBER: | YOUR FIRM'S PERMIT, STATE REGISTRATION OR ID NUMBER |
| 9. | AUTHORIZED SIGNATURE: |
SIGNATURE SHOULD BE BY AN OWNER, PARTNER, OR CORPORATE OFFICER |
| 10. | DATE: | DATE THE FORM WAS SIGNED AND COMPLETED |