Marine Diesel Purchase Certificate Form - Rhode Island Department Of Administration

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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF ADMINISTRATION
DIVISION OF TAXATION
MARINE DIESEL PURCHASE CERTIFICATE
______________________________________________
________________________
(Name of Seller)
(Date)
__________________________________________________________________________
(Address)
PURCHASES COVERED BY THIS CERTIFICATE
Date of Purchase
Number of Gallons
Date of Purchase
Number of Gallons
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
________________
_________________
I hereby certify under penalties of perjury that the diesel fuel described
above is purchased for the following indicated purpose and is exempt from
the gasoline tax pursuant to Chapter 36, Section 1 of the Rhode Island
gasoline tax law.
1.
_____ The fuel purchased will be used by me for the propulsion of
marine craft.
2.
_____ I operate a marine at (address)_________________________________
and the fuel purchased will be sold by me to marine craft to be used
for the propulsion of said craft.
3.
_____ I am in the business of selling marine diesel and the fuel
purchased
under
this
certificate
will
be
sold
to
the
following
taxpayers:
NAME AND ADDRESS
TYPE OF BUSINESS
# OF
GALLONS
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
(attach additional sheets if necessary)
1

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