Declaration of Exemption From California State Sales Tax

I,
declare that I am a member of a Federally Recognized Native American Tribe, based and living on the Cahuilla Indian Reservation.
On
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, I purchased
from
(seller)
No California State Sales Tax was collected because of the Merchandise was delivered by the Seller to my physical address of 52701 Highway 371, Anza CA 92539, which is on the Cahuilla Federal Indian Reservation, of which the sale took place there and the total purchase price was $
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I,
, declare that I sold and delivered the goods to,
, on the above named Federal Indian Reservation, and did not collect California Sales Tax on the Transaction pursuant to Title 18 of the California Administrative Code Section 1616. The Buyer has provided or can provide proof of membership and enrollment of the above Tribe.
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