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                  <text>STATE OF TENNESSEE

DEPARTMENT OF RE1rENT.IE
ANDREW JACKSON STATE OFFICE BUILDING
NASHVI LLE, TENNESSEE 37242

4-791 01 g3:5'7..-000'-0

EXEMF.T I ON

N0.

CH I CK ASAI,J
AMET( I CA

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AI1E T.( I CA

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171 50UTH

171 50U'f H H(ll,-t-Yt^lCl0D
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I"1El'1F:'l..lI

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,

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HOl.-LYU'00D

TN :tr}1

1 1l

Undor tho provisions of T.C.A. Soction 67-6-322, this will p.ovido authority trom the T€nnesseo Depanment of
Revenua for tho organization named aboya to make purchasss of langibl€ personal property or taxable services tor
their own use and consumption or to be given sway withoul tho payment of sales or uso tax.
The organizstion must lurnish the 3uppliers of goods and sorvices with t COPY of this lenor prop€rly complotod
below. YOU MUST RETAIN THE ORIGINAL FOR COPY PURPOSES. The supplier will mrintain a file copry as evidence
of ax€mption. Later purchases do not rrquirr tha 3ubmi$ion of a lettor. The invoicos should contain tho ntmo of the
organization and tho number eivBn 8bova.
This authority doos not sxtond to purchases mado by employeos ol ths organization when omployeos p8y for itoms
purchascd or sorvicos ronderod with p€rsonal funds. lt do€s not extond to itoms purchased to bo rosoid.
THE ORGANIZATION,MUST NOTIFY THE OEPARTMENT IMMEDIATELY IF IT CEASES TO EXIST, MOVES, OR IN ANY
WAY CHANGES THE ORGANIZATION FROM ITS PRESENT FORM.

DATE

DEC O 1 I9B7

COMMISSIONER OF REVENUE

TO BE COMPLETED BY THE ORGANIZATION (please print)

TO:

SUPPUER,S NAME
ADDRESS
C]TY

STATE
as an authorized reprosontative of the

orgtnizltion nrmod lboya rrtirm thst tho purchases m.do under this authority will b. ulod and consumcd by the
orglnitltion or givon tway. Itunhor affirm that the organization will not use this authority to purchaso itoms for

rorle,

Under penslty of perjury, I affirm this to be a true and correct statement.

-ZIP
PRINT NAME OF ORGANIZATION:

PRINT NAME OF PURCHASER:
SIGNATURE OF PURCHASER:
RV-l901 (Rev.8-89)

\

DATE:
13-037-0809

Hr.

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                <text>Chickasaw Council Executive Board</text>
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            <text>Cl'{ IIKAiiAt,J llOtJNC:tt.-, FOY iiCt]UI'ti tJt--&#13;
AI1E T.( I CA&#13;
171 50U'f H H(ll,-t-Yt^lCl0D&#13;
l-'l[::l'1F'['lI$, Tl'{ ::tiil 1 :,i&#13;
STATE OF TENNESSEE&#13;
DEPARTMENT OF RE1rENT.IE&#13;
ANDREW JACKSON STATE OFFICE BUILDING&#13;
NASHVI LLE, TENNESSEE 37242&#13;
EXEMF.T I ON&#13;
E.l''1&#13;
CH I CK ASAI,J&#13;
AMET( I CA&#13;
171 50UTH&#13;
I"1El'1F:'l..lI S ,&#13;
N0. 4-791 01 g3:5'7..-000'-0&#13;
c0tJNC I L , rJ[iY $C0Uf ii; [ir-'&#13;
HOl.-LYU'00D&#13;
TN :tr}1 1 1l&#13;
Hr.&#13;
Undor tho provisions of T.C.A. Soction 67-6-322, this will p.ovido authority trom the T€nnesseo Depanment of&#13;
Revenua for tho organization named aboya to make purchasss of langibl€ personal property or taxable services tor&#13;
their own use and consumption or to be given sway withoul tho payment of sales or uso tax.&#13;
The organizstion must lurnish the 3uppliers of goods and sorvices with t COPY of this lenor prop€rly complotod&#13;
below. YOU MUST RETAIN THE ORIGINAL FOR COPY PURPOSES. The supplier will mrintain a file copry as evidence&#13;
of ax€mption. Later purchases do not rrquirr tha 3ubmi$ion of a lettor. The invoicos should contain tho ntmo of the&#13;
organization and tho number eivBn 8bova.&#13;
This authority doos not sxtond to purchases mado by employeos ol ths organization when omployeos p8y for itoms&#13;
purchascd or sorvicos ronderod with p€rsonal funds. lt do€s not extond to itoms purchased to bo rosoid.&#13;
THE ORGANIZATION,MUST NOTIFY THE OEPARTMENT IMMEDIATELY IF IT CEASES TO EXIST, MOVES, OR IN ANY&#13;
WAY CHANGES THE ORGANIZATION FROM ITS PRESENT FORM.&#13;
DATE DEC O 1 I9B7&#13;
COMMISSIONER OF REVENUE&#13;
TO BE COMPLETED BY THE ORGANIZATION (please print)&#13;
TO: SUPPUER,S NAME&#13;
ADDRESS&#13;
C]TY STATE&#13;
-ZIP&#13;
as an authorized reprosontative of the&#13;
orgtnizltion nrmod lboya rrtirm thst tho purchases m.do under this authority will b. ulod and consumcd by the&#13;
orglnitltion or givon tway. Itunhor affirm that the organization will not use this authority to purchaso itoms for&#13;
rorle,&#13;
Under penslty of perjury, I affirm this to be a true and correct statement.&#13;
PRINT NAME OF ORGANIZATION:&#13;
PRINT NAME OF PURCHASER:&#13;
SIGNATURE OF PURCHASER:&#13;
RV-l901 (Rev.8-89)&#13;
DATE:&#13;
13-037-0809&#13;
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              <text>Andrew Schrack</text>
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