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COMMERCIAL USE OF THE STATE SEAL OF TEXAS
MANUFACTURER/VENDOR'S AFFIDAVIT OF SALES TO STATE AGENCIES AND/OR ELECTED OFFICIALS

I__________________________________________________, _________________________________ of (officer's title) (name of authorized officer of manufacturer or vendor) _____________________________________________ certify that ________________________________
(name of manufacturer or vendor) [description of product(s)]

________________________________________________________________________________________ (description continued)

will not be made available to the general public.

Sales will be made only to:
[ Please mark applicable item(s)]

1. _____ an elected official for a political purpose. 2. _____ a Texas State Agency for an official use in performing a State function.

____________________________________
Signature of officer of manufacturer or vendor

State of _____________________ County of ________________ Sworn to and subscribed before me on the ______ day of ___________________________, __________.

(Seal of officer administering oath)

____________________________________
Signature of officer administering oath

FORM #3303 Oct. 1999