TEXAS MAQUILADORA EXEMPTION CERTIFICATE
Name of purchaser
Maquiladora exemption permit number
City, state, ZIP Code
The undersigned hereby claims exemption from the payment of state and local taxes on its purchases of taxable items for export to Mexico from: Seller: ________________________________________________________________________________________ Street address: _________________________________________________________________________________ City, state, ZIP Code: ____________________________________________________________________________ This certificate will remain in effect until the seller is otherwise notified and does not cover purchases of taxable items to be resold in the form in which they are purchased. The undersigned agrees to accrue and pay tax to the Texas Comptroller of Public Accounts on any goods purchased under this certificate that are not exported to Mexico prior to their use. This certificate is not valid unless accompanied by a copy of the Maquiladora Export Permit issued by the Texas Comptroller of Public Accounts.
Name of permit holder (Type or print) Authorized signature Date