California Tax Exempt Form

CDTFA-230-G-1 REV. 1 (12-17)
CERTIFICATE A
CALIFORNIA SALES TAX EXEMPTION
CERTIFICATE SUPPORTING BILL OF LADING

STATE OF CALIFORNIA
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

Sales of tangible personal property free from sales tax under section 6385(a) of the California Revenue and Taxation Code.

This is to certify, that the , the purchaser of the tangible personal property described herein, is a common carrier lawfully authorized and permitted to operate as such under the laws of the United States, having been issued

INSERT PERMIT OR CERTIFICATE NUMBER*

by the

INSERT NAME OF AGENCY ISSUING CERTIFICATE OR PERMIT*

that the personal property purchased exempt from sales tax reimbursement is to be shipped by the seller via the purchasing carrier's facilities under a bill of lading from

INSERT POINT OF ORIGIN

to

INSERT POINT OF DESTINATION

the out-of-state destination, for use by the in the conduct of its business as a common carrier, and that the is legally authorized to transport cargo under the aforementioned common carrier rights over the routes in or through this state by which it will transport the personal property.

This is also to certify that the property purchased will not be used to carry a payload or for any other purpose prior to its delivery at the destination point.

Description of property to be purchased:

PURCHASER*

Phone Number

Please enter a valid phone number.

Email

example@example.com

ADDRESS (street, city, state, zip code)

SIGNATURE*

DATE

Date

Regulation 1621