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EXPORT
DECLARATION
STATEMENT
OF EXEMPTION OF PURCHASE OF TANGIBLE PERSONAL PROPERTY FOR
REMOVAL FROM THE STATE OF
FLORIDA
BY A NON-RESIDENT DEALER.RULE 12A-1064 FLORIDA ADM. CODE
Name of
selling dealer:
DOLPHIN
DISTRIBUTORS
7344 NW
56 Street Miami, Florida 33166
Name of
Non-Resident
dealer:____________________________________________________________________________
Address:
_____________________________________________________________________________________________
Country:
_____________________________________________________________________________________________
Passport
and Visa
number:______________________________________________________________________________________________
Form I-94
Number (Arrival-Departure Card
Number:___________________________________________________________
Foreign
Business Name:
_________________________________________________________________________________
THIS IS
TO CERTIFY THAT THE TANGIBLE PERSONAL PROPERTY DESCRIBED BELOW
WILL BE TRANSPORTED OUTSIDE
FLORIDA
FOR RESALE AND NO OTHER PURPOSE.
UNDER
PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ FOREGOING AND
THE FACT ALLEGED ARE TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF.
_______________________________________________
Date: _______________________
Signature
of Non-Resident Dealer
________________________________________________
Printed
name and title of Non-Resident Deale
Description of tangible property:
Invoice
#____________
Invoice Amount:___________________________
Invoice#_____________
Invoice Amount:____________________________
7344
NW 56 Street *
Miami,
Florida
33166
* Tel: (305) 863-6100 * Fax (208) 694-5431 * www.dolphindistributors.com
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