Form of Certificate of Non Liability to State Taxes SALES TAX/ AGRICULTURAL INCOME TAX/ PROFESSIONS TRADES CALLING AND EMPLOYMENT TAX/ AMUSEMENT AND BETTING TAX/ MOTOR SPIRIT AND LUBRICANT TAX/ TAXES ON GOODS CARRIED BY ROAD OR INLAND WATERWAYS TO BE PRODUCED BY AN APPLICANT FOR CONTRACTS, PERMITS LEASES, LICENSES ETC. 1. Name & address of the applicant : 2. Occupation of the applicant : 3. Father's name of the applicant : 4. Home address of the applicant : 5. The applicant is not liable to State Taxes (Sales Tax, Agricultural Income Tax/Profession Trades Calling & Employment Tax/ Amusement and Betting Tax/Motor Spirit and Lubricant Tax/ Taxes on goods carried by Roads or Inland waterways.) Place :.......... Signature of the applicant Date :........... VALID UPTO (To be certified by the Taxing authority) Certified that applicant mentioned above is not liable to pay all the taxes. Date: Unit: Signature of Superintendent of taxes Sale: District: Agricultural Income-Tax Office
