This form can be filed only by Resident Tribal Members and Tribal Entities of a tribe that has an implemented Tax Agreement with the State of Michigan where the tribe has not authorized its Resident Tribal Members and Tribal Entities to use Tribal Certificate of Exemption, Form 3998. Where the Resident Tribal Members or Tribal Entitys tribe has authorized its Resident Tribal Members and Tribal Entities to use the Tribal Certificate of Exemption, Form 3998, this form must be used to claim exemption for purchases described in Part 4 and only for those purchases.

The terms Resident Tribal Member, Tribal Entity, Agreement Area, and Tribal and Trust Lands are defined in the Tax Agreement between the purchasers federally-recognized tribe and the State of Michigan.

This form is not intended to modify the terms of the Tax Agreement and the validity of any claim shall be determined solely under the Agreement.

Where original documents are requested, copies are not acceptable and will not be accepted.

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