To Our Tax-Exempt Visitors:

In order for us to comply with Florida Department of Revenue regulations regarding tax-exempt groups, we request
your cooperation in completing the form below.

We know that completing this form is both time-consuming and confusing; however, officials at the Florida
Department of Revenue have advised us that it is required in order for us to admit your group without
adding sales tax.

Additionally, the taxing authorities have informed us that in order for purchases to be tax-exempt, payment must
be made in the form of a check from the tax-exempt institution or a credit card in the name of the institution.
Cash, personal checks, or personal credit cards cannot be accepted for tax-exempt sales [State of
Florida Department of Revenue Rule 12A-1.061(13)].

In the event your group arrives with a form of payment that does not meet the requirements for a tax-exempt sale,
we will be glad to admit your group on a taxable basis.

Thank you very much for your cooperation.

Lion Country Safari, Inc. Florida

The undersigned hereby affirms that:

(Your Name) is a representative of the exempt governmental 
or nonprofit organization identified below and that the purchase of tangible personal property or services, or the
rental of living accommodations made on (Date) from Lion Country Safari, Inc. Florida is for the
use by the exempt governmental or nonprofit organization. The undersigned further affirms that the charges for the
purchase of lease of tangible personal property or services or the rental of living accommodations from Lion Country
Safari will be billed to and paid directly by the exempt governmental or nonprofit organization.

Authorized signature on behalf of the exempt entity: (A Signature Will Be Required Upon Your Group's Arrival)

Name of the exempt entity: 

Address of the exempt entity: 

City: , State:  Zip: 

Consumer's Certificate of Exemption Number: