Sales Tax Exempt Fill in Template

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01-339 (Back) (Rev.

12-02i4) Contact your state agency for THEIR form

TEXAS SALES AND USE TAX EXEMPTION CERTIFICATION


Jack R Patriot
Freedom Ave. 7777 Phone # 333-444-6666
LIBERTY TOWN, TEXAS Non-Domestic
#000000000

I, the purchaser named above, claim an exemption from payment of sales and use taxes (for the purchase of taxable
items described below or on the attached order or invoice) from:

Seller:

Street address: City, State, ZIP code:

Description of items to be purchased or on the attached order or invoice:

FOR THE RECORD; At Law; I am Exempt from Levy based upon


Purchaser claims this exemption for the following reason:
My Unalienable and Unimpeachable Birthright Heritage of the Imprescriptible Common Law Rights of Natural sentient
Man given by The Word of the Almighty Creator, YHVH, the Great I AM. I have the right to buy or sell and My rights
cannot be taxed. By law, all taxes must be paid in gold or silver only. Debt cannot lawfully be used to pay a debt.
"Impossibilium nulla obligatio est." there is no obligation to do the impossible. I, Me, My, Myself, Addressee, hereby
declare the following under the pains and penalties of perjury under the laws of Texas state: I am a Individual Sovereign
Texian American, a Living Soul, Sui Juris, not a corporation, and am of age of majority, of sound mind and competent to
testify, have first hand knowledge of the truths and facts herein being true, correct, complete, certain, and not misleading.
This is not a claim based upon applying for or submitting a resale certificate, nor is this a claim intended for recognition
as a charitable, religious, educational, farm, non-profit or government agency or organization, nor does this exemption
certificate create any adhesion for entry into any foreign jurisdiction. See the following exhibits & or cites; 1836 Texas
Constitution Art. 2, § 2; Declaration of Rights Art 12; TCCrP Art. 43.02; USAC Art. 1. § 8, § 10; 12 USC § 152, § 411;
18 USC § 8; 31 USC § 3124a, § 5112, § 5118; 50 USC § 9898H; 48 Stat. 2, (Mar. 9, 1933), 48 Stat. 113 (June 5, 1933),
HJR 192 (June 5, 1933); Pub. Law 89-31 (July 23, 1965); Pub. Law 90-29 (June 24, 1967); 60 Stat. 596; Perry v. State 61
S.W. 400.
I understand that I will be liable for payment of sales or use taxes. which may become due for failure to comply with the provisions of the
Tax Code: Limited Sales, Excise, and Use Tax Act; Municipal Sales and Use Tax Act; Sales and Use Taxes for Special Purpose Taxing
Authorities; County Sales and Use Tax Act; County Health Services Sales and Use Tax; The Texas Health and Safety Code; Special
Provisions Relating to Hospital Districts, Emergency Services Districts, and Emergency Services Districts in counties with a population
of 125,000 or less.
I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know, at the time of purchase,
will be used in a manner other than that expressed in this certificate and, depending on the amount of tax evaded, the offense may range
from a Class C misdemeanor to a felony of the second degree.

Purchaser Jack Rabbit Patriot Title:Individual Sovereign


With Explicit Reservation of all My Rights, Texian American, Living Soul, Date
Without Dishonor, UCC 1-308 Sui Juris
By:

Autograph(s) with no assured value, no liability


NOTE: This certificate cannot be issued for the purchase, lease, or rental of a motor vehicle.
THIS CERTIFICATE DOES NOT REQUIRE A NUMBER TO BE VALID.
Sales and Use Tax "Exemption Numbers" or "Tax Exempt" Numbers do not exist.
This certificate should be furnished to the supplier. Do not send the completed certificate to the Comptroller of Public Accounts.

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