C9 - Amendment 0003 Attachment 001 Revised SF1094-15c.pdf
Standard Form PDF 1 MB Posted
- Attached to
- Cable Television Services
- Solicitation number
- N6278923Q0023
About this file
This document is a United States Tax Exemption Form used to establish the government's exemption from state or local taxes for purchases made on behalf of the federal government. The form details a purchase of cable television services for exclusive use by the Department of the Navy Naval Sea Systems Command as outlined in solicitation number N6278923Q0023. The form includes the purchaser's office and address, vendor information, item purchased described as cable television services, quantity, unit price, amounts excluded from state and local taxes, and signatures from the purchaser's and vendor's representatives.
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Other versions and copies of SF 1094
| File | Revision | Posted | Attached to |
|---|---|---|---|
| Attachment J-4 U.S. Tax Exemption Form--SF-1094.pdf | Revision not stated | Provide and install two new boilers and decommission and dispose of one existing boiler | |
| tax exempt form SF1094 04-15.pdf | Revision not stated | Steel Toe Safety Shoes/Footwear - OSHA Regulation |
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Text version
UNITED STATES
TAX EXEMPTION FORM
VENDOR FROM WHICH PURCHASED
The information on this form is true and correct to the best of my knowledge and belief.
A tax exemption form has not previously been issued and the described item(s) has (have) been delivered and invoiced pursuant to:
Read the instructions on the reverse side.
NAME
PURCHASE OR
CONTRACT NUMBER
PURCHASER'S OFFICE TITLE
TITLE OF VENDOR'S REPRESENTATIVE
PREVIOUS EDITION NOT USABLE
ADDRESS (Number, Street, City, State, and ZIP Code)
PURCHASER'S ADDRESS
ITEM PURCHASED FOR EXCLUSIVE USE OF THE UNITED STATES GOVERNMENT (Describe)
SERIAL NUMBER
QUANTITY
AMOUNT OF TAX EXCLUDED ($)
FOR ADMINISTRATIVE OFFICE
DESIGNATED OFFICE SYMBOL NUMBER
VOUCHER NUMBER
STATE
LOCAL
DATES
DATE:
DATE:
DATE:
UNIT PRICE ($)
DEPARTMENT, AGENCY, OR OFFICE
STANDARD FORM 1094 (REV. 4/2015)
Prescribed by GSA-FAR (48 CFR) 53.229
SIGNATURE OF VENDOR'S REPRESENTATIVE
PURCHASER'S SIGNATURE
INSTRUCTIONS
1. This form will be used to establish the Government's exemption or immunity from State or Local taxes whenever no other evidence is available.
2. This form shall NOT be used for:
(a) Purchase of quarters or subsistence made by employees in travel status.
(b) Expenses incident to use of a privately owned motor vehicle for which a mileage allowance has been authorized, or
(c) Merchandise purchased which is subject only to Federal Tax.
3. If the spaces provided on the face of this form are inadequate, attach a separate statement containing the required information.
4. If both State and Local taxes are involved, use a separate form for each tax. The form will be provided to the vendor when the prices exclude State or Local tax.
5. The serial number of each form prepared will be shown on the payment voucher.
THE FRADULENT USE OF THIS FORM FOR THE PURPOSE OF OBTAINING
EXCEPTION FROM OR ADJUSTMENT OF TAXES IS PROHIBITED.
STANDARD FORM 1094 (REV. 4/2015) BACK
UNITED STATES TAX EXEMPTION FORM
VENDOR FROM WHICH PURCHASED
The information on this form is true and correct to the best of my knowledge and belief.
A tax exemption form has not previously been issued and the described item(s) has (have) been delivered and invoiced pursuant to:
Read the instructions on the reverse side.
NAME
PURCHASE OR CONTRACT NUMBER
PURCHASER'S OFFICE TITLE
TITLE OF VENDOR'S REPRESENTATIVE
PREVIOUS EDITION NOT USABLE
ADDRESS (Number, Street, City, State, and ZIP Code)
PURCHASER'S ADDRESS
ITEM PURCHASED FOR EXCLUSIVE USE OF THE UNITED STATES GOVERNMENT (Describe)
SERIAL NUMBER
QUANTITY
AMOUNT OF TAX EXCLUDED ($)
FOR ADMINISTRATIVE OFFICE
DESIGNATED OFFICE SYMBOL NUMBER
VOUCHER NUMBER
STATE
LOCAL
DATES
UNIT PRICE ($)
DEPARTMENT, AGENCY, OR OFFICE
STANDARD FORM 1094 (REV. 4/2015)
Prescribed by GSA-FAR (48 CFR) 53.229
INSTRUCTIONS
1. This form will be used to establish the Government's exemption or immunity from State or Local taxes whenever no other evidence is available.
2. This form shall NOT be used for: (a) Purchase of quarters or subsistence made by employees in travel status. (b) Expenses incident to use of a privately owned motor vehicle for which a mileage allowance has been authorized, or (c) Merchandise purchased which is subject only to Federal Tax.
3. If the spaces provided on the face of this form are inadequate, attach a separate statement containing the required information.
4. If both State and Local taxes are involved, use a separate form for each tax. The form will be provided to the vendor when the prices exclude State or Local tax.
5. The serial number of each form prepared will be shown on the payment voucher.
THE FRADULENT USE OF THIS FORM FOR THE PURPOSE OF OBTAINING EXCEPTION FROM OR ADJUSTMENT OF TAXES IS PROHIBITED.
STANDARD FORM 1094 (REV. 4/2015) BACK
11.0.0.20130303.1.892433.887364
| Voucher Number: |
| Amount excluded from Local Taxes: |
| Voucher Date: |
| Purchaser's Signature Date: |
| Vendor's Representative Signature Date: |
| Amount excluded from State Taxes: |
| Unit Price: |
| SignatureField1: |
| Purchaser's Address: |
File details come from the government source that posted it. Updated .