Washington Certification of Use and/or Deferred Sales Tax Paid

Certification of Use and/or Deferred Sales Tax Paid
Certification of use and/or deferred sales tax paid
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Certification of Use and/or Deferred Sales Tax Paid
SUBMIT THIS CERTIFICATE IN DUPLICATE

This statement is made for the purpose of relieving named seller from liability for collection and payment of the
tax due on articles upon which use tax and/or deferred sales tax has already been paid directly to the
Department of Revenue as listed below.
Any items paid are to be indicated separately as to date and amount of tax paid. If any articles are purchased
for resale, a Reseller Permit should be provided the seller per Washington Administrative Code
(WAC) 458-20-102.
The undersigned hereby certifies that he/she has paid directly to the Washington State Department of Revenue
the full amount of all use or deferred sales tax due and payable by reason of use in said state of that certain
tangible personal property heretofore purchased from:
Name of Seller

Address of Seller

and particularly described in the following invoices issued by said seller:
Invoice
No.

Invoice
Date

Purchase
Price

Date
Tax Paid

Articles Purchased

Tax Return
or Document

Amount
of Tax

NOTE: All tax still due and unpaid is to be remitted to the seller per chapter 82.08.050 Revised Code of
Washington (RCW).
Purchaser’s Firm Name:

Purchaser’s Account ID

Purchaser’s Signature:
By:

Date

Purchaser’s Name and Title (Please Print)
FOR DEPARTMENT OF REVENUE USE ONLY
/

Verified By

/

Date

For tax assistance or to request this document in an alternate format, please call 360-705-6705. Teletype (TTY) users may
use the Washington Relay Service by calling 711.
REV 31 0033 (06/21/19)
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