(for office use only)
US Marshals Service Online Bidding
Certification Form
In accordance with title 18, U.S.C., section 1963(g) and title 21, U.S.C., section 853(h), I certify that I am not acting and will not act in concert with the defendant(s) from whom the property was seized. I understand that any falsification of the information provided in this statement is punishable under the provisions of title 18, U.S.C., section 1001, by a fine of not more than $10,000 or by imprisonment of not more than 5 years, or both. All sales are subject to confirmation by the US Marshals Service.
Name (print):
Date of Birth:
Place of Birth:
Social Security No.:
Driver's License No. and Issuing State:
Shipping Address:
Email Address:
Fax Number:
Telephone Number(s):
Signature:
Date of Signature:
THE SECTION BELOW MUST BE FILLED OUT COMPLETELY (INCLUDING SIGNED AND DATED) IF YOU INTEND TO RESALE OR CLAIM ANY TAX EXEMPTION. OTHERWISE, APPLICABLE TAXES (IF ANY) WILL BE APPLIED.
Company Name:
(if representing)
Type of Business:
Name of Principal Owner(s) of Company:
Company Address:
Owner(s) Date of Birth(s):
Owner(s) Social Security No(s):
Telephone Number(s):
Sales Tax ID Number:
THE TAXABLE ITEMS DESCRIBED ON THE ORDER / INVOICE, WILL BE RESOLD, RENTED, OR LEASED BY ME WITHIN THE GEOGRAPHICAL LIMITS OF THE UNITED STATE OF AMERICA, ITS TERRITORIES AND POSSESSIONS, OR WITHIN THE GEOGRAPHICAL LIMITS OF THE UNITED MEXICAN STATES, IN THEIR PRESENT FORM OR ATTACHED TO OTHER TAXABLE ITEMS TO BE SOLD. I UNDERSTAND THAT IF I MAKE ANY USE OF THE ITEMS OTHER THAN RETENTION, DEMONSTRATION OR DISPLAY WHILE HOLDING THEM FOR SALE, LEASE OR RENTAL, I MUST PAY SALES TAX ON THE ITEMS AT THE TIME OF USE BASED UPON EITHER THE PURCHASE PRICE OR THE FAIR MARKET RENTAL VALUE FOR THE PERIOD OF TIME USED. I UNDERSTAND THAT IT IS A CRIMINAL OFFENSE TO GIVE A RESALE CERTIFICATE TO THE SELLER FOR TAXABLE ITEMS THAT I KNOW, AT THE TIME OF PURCHASE, ARE PURCHASED FOR USE RATHER THAN FOR THE PURPOSE OF RESALE, LEASE, OR RENTAL AND, DEPENDIGN ON THE AMOUNT OF TAX EVADED, THE OFFENSE MAY RANGE FROM A CLASS C MISDEMEANOR TO A FELONY OF THE SECOND DEGREE.
Owner's Signature:
Date of Owner's Signature:
Information provided on this form will be held in strict confidence and will be used only to ascertain compliance with the Comprehensive Crime Control Act of 1984 and will be disposed of in accordance with law.