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Ll remit the tax due under the Provincial Sales Tax Act. I acknowledge that if I make a false statement to avoid paying tax, the Provincial Sales Tax Act charges a ine of up to $10,000 and/or imprisonment up to two years, in addition to a penalty of 25% of the tax due and an assessment for the tax that should have been paid. FULL LEgAL NAME SIgNAtURE DAtE SIgNED YYYY / MM / DD X FIN 490/WEB Rev. 2013 / 6 / 25 Page 1 CertifiCate of exemption general For more information on this certiica.

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