Exemption Certificate
(OVERSEAS TELEPHONE CALLS)
(Date) ____________________________ 19____
I certify that the toll charges of $__________
are for telephone or radio telephone messages originating at __________________________
(Point of origin)
within a combat zone from _______________________________
(Name)
a member of the Armed Forces of the United States performing service in such combat zone; that the transmission facilities were furnished by ____________________ (Name of carrier); and that the charges are exempt from tax under section 4253(d) of the Internal Revenue Code.
_______________________________
(Signature of subscriber)
_______________________________
(Address)
Note: Penalty for fraudulent use, $10,000 or imprisonment or both.
26 C.F.R. §49.4253-4