CERTIFICATE OF PERSON BUYING AVIATION-GRADE KEROSENE FOR USE AS A FUEL IN AN AIRCRAFT
(TO SUPPORT TAX-FREE REMOVALS AND ENTRIES OF AVIATION-GRADE KEROSENE UNDER SECTION 4082 OF THE INTERNAL REVENUE CODE.)
______________________________________(Buyer) certifies the following
Name of Buyer
under penalties of perjury:
The aviation-grade kerosene to which this certificate applies will be used by Buyer as a fuel in an aircraft or resold by Buyer for that use.
This certificate applies to ________ percent of Buyer's purchases from ________________________ (name, address, and employer identification number of seller) as follows (complete as applicable):
1. A single purchase on invoice or delivery ticket number ____________.
2. All purchases between ____________ (effective date) and ____________ (expiration date) (period not to exceed one year after the effective date) under account or order number(s) ____________. If this certificate applies only to Buyer's purchases for certain locations, check here ________ and list the locations.
_______________________________
_______________________________
_______________________________
Buyer is buying the kerosene for (check either or both as applicable): ____ Buyer's use as a fuel in an aircraft. ____ Resale for use as a fuel in an aircraft.
Buyer will provide a new certificate to the seller if any information in this certificate changes.
If Buyer sells the aviation-grade kerosene to which this certificate relates and does not deliver it into the fuel supply tank of an aircraft, Buyer will be liable for tax unless Buyer obtains a certificate from its buyer stating that the aviation-grade kerosene will be used as a fuel in an aircraft.
If Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's right to provide a certificate.
Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn.
The fraudulent use of this certificate may subject Buyer and all parties making any fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution.
_______________________________
Printed or typed name of person signing
_______________________________
Title of person signing
_______________________________
Employer identification number
_______________________________
Address of Buyer
_______________________________
Signature and date signed
26 C.F.R. §48.4082-6