Form Scc-2 - Spill Compensation And Control Tax Secondary Transfer Certificate - 2001
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1
2State of New Jersey
Division of Taxation
S
C
C
T
PILL
OMPENSATION AND
ONTROL
AX
S
T
C
ECONDARY
RANSFER
ERTIFICATE
Read Instructions on Reverse Side of this Certificate
To be completed by Transferor and given to and retained by Transferee
The Transferee must pay the tax on the receipt of taxable hazardous substances unless
the Transferor gives him a properly completed exemption certificate.
TO:
___________________________________________________________
________________________________
(Name of Transferee)
(Date)
___________________________________________________________
(Federal Identification Number)
___________________________________________________________________________________________________________
(Address)
(City)
(State)
(Zip Code)
The undersigned certifies that:
1. a) He is duly and properly registered with the New Jersey Division of Taxation, Spill Compensation and Control Tax;
or
b) He is in receipt of a properly issued Secondary Transfer Certificate.
2. He engages in the transfer of petroleum or other hazardous substances described as being taxable under
N.J.A.C.7:1E-1.3(j).
3. The product herein transferred is described as:
______________________________________________________________________________________________
______________________________________________________________________________________________
4. The product described in (3) above was received by him in a taxable manner and said tax has been duly paid.
I, the undersigned Transferor, have read and complied with the instructions and rules promulgated pursuant to the New
Jersey Spill Compensation and Control Act with respect to the use of the Secondary Transfer Certificate and it is my belief that
the Transferee is not required to pay the tax on the transaction or transactions covered by this Certificate. The undersigned
Transferor hereby swears (under the penalties for perjury and false swearing) that all the information shown in this Certificate
is correct.
_____________________________________________________________________________________________________
Name of Transferor (as registered with Division of Taxation)
Federal Identification Number
By
_____________________________________________________________________________________________________
(Signature of duly Authorized Office)
(Title)
_____________________________________________________________________________________________________
(Address)
(City)
(State)
(Zip Code)
SCC-2
MAY BE REPRODUCED
4-01, R-3
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