STATE OF RHODE ISLAND DEPARTMENT OF REVENUE DIVISION OF TAXATION

SALES AND USE TAX MANUFACTURER'S EXEMPTION CERTIFICATE

NAME OF SELLER :	::Se:ricnS	maal.

DATE	._,9Jl---'-'/[.p-+-'laq..,,cD--=-i;a	'C;;_, 

ADDRESS OF SELLER	

UNDER PENALTIES OF PERJURY, I HEREBY CERTIFY THAT THE PROPERTY HEREIN DESCRIBED IS PURCHASED FOR THE FOLLOWING INDICATED PURPOSE AND IS EXEMPT FROM THE SALES OR USE TAX PURSUANT TO CHAPTER 18, SECTION 30 (7) OR (22) OF THE RHODE ISLAND SALES AND USE TAX LAW:

[ ] THE PROPERTY DESCRIBED BELOW IS PURCHASED FOR THE PURPOSE OF BEING MANUFACTURED IN THIS STATE INTO A FINISHED PRODUCT FOR RESALE AND BECOMES A RECOGNIZABLE, INTEGRAL PART OF SUCH FINISHED PRODUCT.
[ i/j THE PROPERTY DESCRIBED BELOW WILL BE USED IN THIS STATE IN AN INDUSTRIAL PLANT IN THE ACTUAL MANUFACTURE, CONVERSION, OR PROCESSING OF TANGIBLE PERSONAL PROPERTY, OR TO THE EXTENT
USED IN CONNECTION WITH THE ACTUAL MANUFACTURE, CONVERSION OR PROCESSING OF COMPUTER SOFTWARE AS THAT TERM IS UTILIZED IN INDUSTRY NUMBERS 7371, 7372 AND 7373 IN THE STANDARD INDUSTRIAL CLASSIFICATION, OFFICE OF STATISTICAL STANDARDS, EXECUTIVE OFFICE OF THE PRESIDENT, UNITED STATES BUREAU OF THE BUDGET, AS REVISED FROM TIME TO TIME, TO BE SOLD, OR USED IN THE FURNISHING OF POWER TO AN INDUSTRIAL MANUFACTURING PLANT.

OEscR1PnoN oF PROPERTY, J:i1,n ti-.li,veh. 

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IF THE TANGIBLE PERSONAL PROPERTY UNDER THIS CERTIFICATE IS USED TO ANY EXTENT IN A TAXABLE MANNER, I (WE) AGREE TO FILE THE APPROPRIATE USE TAX RETURNS AS REQUIRED BY R.I. REGULATION 280-RICR-20-70-19 AND THE RHODE ISLAND SALES AND USE TAX LAW.

NAME OF PURCHASER	Qw11ed '.P\(\;:rliC.,$\eth

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ADDRESS OF PURCHASER _y _.., 5_...., =.:..  .......f......l'.i...tr)Ll....LIY'Cn'--'--"""--.  R.1...-">,d 	_

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SIGNATURE OF PURCHASER OR AGENT _.,,  ..._..64......_,f-:-'1;;:-::;,-,:c..=:....==-------------- IF CORPORATION GIVE NAME AND TITLE OF CORPORA	OFFICER QodYB.J  J	ve.
CHECK APPLICABLE:	SINGLE PURCHASE CERTIFICATE [	]
BLANKET CERTIFICATE	[ f/'1

THIS FORM IS APPROVED BY THE DIVISION OF TAXATION AND MAY BE REPRODUCED

R.I. Regulation 280-RICR-20-70-19