AGRI-STARTS, INC.: Affidavit For Nonresident Dealer

Statement for Exemption of Purchases of Tangible Personal Property for removal from the state by a nonresident dealer.
Business Name ____________________________________________________________________
Address:___________________________________________________________________________
City & State: _______________________________________________________________________
Phone No: ___________________________	Fax No:_____________________________
Sales Tax Registration Number:___________________________________________________
Name:__________________________________________________
This is to certify that the tangible personal property will be transported outside of Florida for resale and no other purpose.
Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true to the best of my knowledge and belief.
Signature of nonresident dealer:_____________________________________________
Date:________________________
***** Whether you are a past or present customer, we appreciate your cooperation in completing this form. Please remember to sign and date the form. We need this information in our records for the State of Florida.

1728 Kelly Park Road · Apopka, FL 32712 · Tel: (407) 889-8055 · Fax: (407) 889-2523