I hereby certify that I hold valid seller's permit number .......... issued pursuant to chapters 372, 374 and 377 of the Nevada Revised Statutes; that I am engaged in the business of selling ..........; and that the tangible personal property described in the second paragraph of this certificate, which I purchase from: ................................, will be resold by me in the form of tangible personal property. I further certify that in the event any of the property is used for any purpose other than retention, demonstration or display while I am holding it for sale in the regular course of business, it is understood that I am required by chapters 372, 374 and 377 of the Nevada Revised Statutes to report it and pay the tax measured by the purchase price of the property.
Description of the property to be purchased:
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Purchaser....................................................................
Address
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Signature of Authorized Purchaser
Dated: .......... (day) of ............ (month) of ........ (year)
at.....................................................
Nev. Admin. Code § 372.730
NRS 360.090, 360.200, 360B.110, 372.725, 374.725