GM-10-10-27-005 Membership Application and Certificate
Pedernales Electric Cooperative, Inc.
P O Box 1 •Johnson City,Texas 78636. 1-888-554-4732
1 apply for membership in Pedernales Electric Cooperative, Inc. to be connected to and receive
service from the Cooperative's electric distribution system. I agree to pay for Cooperative services
and to abide by the Cooperative's Bylaws, Tariff, policies and procedures. I authorize agents of
the Cooperative to enter and will allow easy access to my property to repair and maintain fines or
equipment or for any other purpose necessary to provide services and conduct business.
Date: �J �-., 2,01 Account Number:
Name: Y1 , �1 T Cyfat g�E'�oY1 l W aj_e�c 3yegi�Y�A- Va►' +
�� C � or��� V4�►II (rt ��a✓I_
Address: t'10V NY IOMIAStYI' vt Blya
(City) (State) (Zip)
Telephone Number: } (512)-205-9151
(Home) (Work) (Other)
Location Description: Nme� - Plant
FEES: $ 5a co Membership Fee (Refundable when account is closed)
$ U±J Establishment Fee (Nonrefundable)
$ Other
$ Tax bC*kzVi 1 "���X X t P •
$ - =-i-.-ice - Total
00
PEC Representative PECCISFo02
This certifies the above applicant is a member of Pedernales Electric Cooperative, Inc.
jt4,1Cl- l 0 2�)--7-vu
01-338(as*)
"718)
TEXAS SALES AND USE TAX EXEMPTION CERTIFICATION 320
of purchaser.fl or agency
10 W J LA
AA ss(Street d tumber,P.O,Box or umber) Phone(Area code and number)
10 l 9• I h 51
City,State,Z)P code Fr `
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I,the purchaser named above, claim an exemption from payment of sales and use taxes(for the purchase of taxable
items described below or on the attached order or Invoice)from:
Seller: �P f1{ �,t<t � 'oqw # In t;,
Street address: P. O. Box I City,State,ZIP code: ID A C� + X
-716
Description of items to be purchased or on the attached order or invoice:
Wfle �+tt pSGc 11t1�YYt- , - �' S `�- a,r
Purchaser claims this exemption for the following reason:
be-VA i tiAx 4-px D + (2 t A—CAj)
I understand that 1 will be liable for payment of all state and local sales or use taxes which may become due for failure to comply with
the provisions of the Tax Code and/or all applicable law.
I understand that it is a criminal offense to give an exemption certificate to the seller for taxable items that I know,at the time of purchase,
will be used in a manner other than that expressed In this certificate,and depending on the amount of tax evaded,the offense mayrange
from a Class C misdemeanor to a felony of the second degree.
Pu aser Tttle Date
sig
� # 1 o
NOTE: This certificate cannot be issued for the purchase,lease,or rental of a motor vehicle.
THIS CERTIFICATE DOES NOT REQUIRE NUMBER TO BE VALID.
Sales and Use Tax"Exemption Numbers"or*Tax Exempt'Numbers do not exist.
This cerIfficatti should be furnished to the supplier.Do not send the completed certificate to the Comptroller of Public Accounts.