FIRM NAME _________________ ____________________________________________

I HEREBY CERTIFY,
That I hold valid seller's permit No. __________________________
issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling:

_________________________________________________________________________

that the tangible personal property described herein which I shall purchase from:

THE LOS ANGELES FLOWER DISTRICT AND ITS VENDORS

will be resold by me in the form of tangible personal property; PROVIDED, however, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such property.

Description of property to be purchased: ______________________________________________________

________________________________________________________________________________________

Purchaser _______________________________________________________________________________

By and Title ______________________________________________________________________________

Address _________________________________________________________________________________

_________________________________________________________________________________________

Dated _______________________________________________

At ______________________________________________________________________________________

Phone (__________) ____________________________________