STATE AND LOCAL TAX-EXEMPTION CERTIFICATE

Organization: City of Nashua

Account Number:

Address: 229 Main Street

City: Nashua State: NH Zip: 03061-2019

The services which I purchase from ___________________ are tax-exempt for state and local purposes because my organization is:

A government entity

I understand that all services purchased from __________________ are considered tax-exempt unless notified in writing. If any service purchased under this certificate is used for a non-exempt purpose, it is my responsibility to report and pay any tax due.

This Certificate shall cover the following state and local jurisdictions:

Jurisdiction Tax Exempt Number

State: New Hampshire 026000581

City or Local: Nashua

Customer’s Name: Title:

Signature: Date: