For buyers that reside outside of MA

Please submit this form with either A or B: Para compradores que residen fuera de Massachusetts
A) Submit this form printed on your business letterhead with your company name and address or
B) Submit this form attached with your business card
Por favor, envía este formulario con opción A o B:
A) Impreso en tu membrete de negocios con el nombre y dirección de tu empresa o
B) Grapa o escanea junto con tu tarjeta de negocios

BLANKET STATEMENT FOR PURCHASE OF MOTOR VEHICLES

BY NONRESIDENT FOR RESALE OUTSIDE MASSACHUSETTS

I am more than 18 years of age, under no legal disabilities, and competent to attest to the
matter stated herein. All statements noted below are true, accurate, and are based upon my personal
knowledge and belief.

I declare, under the pains and penalties of perjury, that I am a duly licensed dealer in the
Libya
Country of ___________________ 4811
(registration or permit# ______________________________) and
not engaged in business in Massachusetts within the meaning of G.L. c. 64H, § 1. I further declare that
the tangible personal property purchased from Insurance Auto Auctions Inc and Subsidiaries is solely for
resale in the ordinary course of my business.

This statement is made in good faith and pursuant to the sales and use tax laws of the State of
Massachusetts.

This ___________
September day of ______________________,
10 20______,
20

TAHA ABDULKARIM ABDULFATAH ALFALAH

_____________________________________________________________________________________

DEALER (PURCHASER) FIRM NAME

Al Hamidah - Benghazi , Libya , 00000
_____________________________________________________________________________________

ADDRESS (Street) (City) (State) & (ZIP)

_________________________________________ Owner
_______________________________________

BY (Signature) TITLE
TAHA ABDULKARIM ABDULFATAH ALFALAH
_________________________________________

WRITTEN NAME

SPECIAL NOTE:
Buyer acknowledges and agrees that all vehicles purchased through the auction facilities and subsequently
exported out of the U.S. shall be “routed export transactions” under section 30.3(e) of the Foreign Trade
Regulations (15 C.F.R. § 30.3(e)), in which the buyer is acting as the Foreign Principal Party in Interest, and neither
the auction nor the providers who sell vehicles through the auction’s facilities will be the “exporter” as defined
under the Export Administration Regulations (15 C.F.R. Parts 730-774)(“EAR”). The buyer further covenants and
warrants to the auction that, with respect to vehicles purchased through the auction’s facilities, the buyer shall
comply with all export and licensing requirements, including but not limited to EAR and its export license and
authorization requirements, customs formalities, re-export and prohibited end use and prohibited end-user
provisions.