"This is to certify that | (Purchasing Bus Company) | of | ||||||||||||||
, | Illinois, a privately owned public utility which owns | |||||||||||||||
and operates 2 axle vehicles designed and used for transporting more than 7 passengers, which vehicles are used as common carriers in general transportation of passengers, are not devoted to any specialized purpose and are operated entirely within the territorial limits of a single municipality or of any group of contiguous municipalities, or in a close radius thereof, and the operations of which are subject to the regulations of the Illinois Commerce Commission, purchased ____ gallons of motor | ||||||||||||||||
fuel, Illinois Motor Fuel Tax exempt, from | (Name of Distributor | |||||||||||||||
or Supplier) | whose address is | |||||||||||||||
on Invoice No | dated | , and said motor fuel is | ||||||||||||||
for use in operating such local transportation system under the limitations specified hereinabove. | ||||||||||||||||
Name of Purchasing Bus Company | ||||||||||||||||
Name of Authorized Representative | ||||||||||||||||
Title of Authorized Representative | ||||||||||||||||
Dated: | , | 20 | " | |||||||||||||
Ill. Admin. Code tit. 86, § 500.285
Amended at 36 Ill. Reg. 6677, effective April 12, 2012