F.o.t. Application 5d/annual Tax Exemt Renewal Report Form Page 2
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2SECTION B: To be completed by Commercial Permit Holders only (Fishing, Logging, Mining, Outfitting,
Trapping, Farming, Tourism, Sawmill)
5. The Fuel Oil Tax Act Section 6(3) limits the issuance of tax exempt permits to those eligible commercial activities
conducted with the intention of earning income.
a) Is your business actively engaged in commercial operations (earning revenue)? _____ Yes
_____ No
b) Does your business intend to earn income (profit)? _____ Yes
_____ No
c) What was your business income (profit) in the last fiscal year? __________________________________________
d) What do you forecast your business income (profit) to be during this current fiscal year? ___________________
e) Should the answer to c or d (above) be a negative figure, please explain how the business intends to earn
income (profit).
___________________________________________________________________________________________________
f) Is greater than 50% of revenue derived from non-arm’s length (related or affiliated) customer?
_____ Yes
_____ No If Yes, provide details: __________________________________________________________
SECTION C: To be completed by Generator Permit Holders only
6. The Fuel Oil Tax Act Section 6(1) states that tax exempt permits may be issued for stationary generators of
electricity. These generator permits may be issued only if the generator meets certain criteria as assessed by
the following questions:
a) Is the generator(s) stationary? _____ Yes
_____ No
b) Is the generator(s) permanently located on land or in a building? _____ Yes
_____ No
c) Is the generator(s) intended to remain so located? _____ Yes
_____ No
d) Is the generator(s) used for temporary service work? _____ Yes
_____ No
e) Is the generator used for the temporary supply of electricity? _____ Yes
_____ No
SECTION D: To be completed by all permit holders
7. If you have used tax exempt fuel, in non-exempt equipment or for a non-exempt purpose, please calculate the
amount of fuel tax due to Yukon Government and submit with this update.
Diesel ______________ L X $0.072 =
$ _______________
Gas
______________ L X $0.062 =
$ _______________
AVGas ______________ L X $0.011 =
$ _______________
Amount Remitted: $ ________________
8. Declaration:
I hereby certify that the information contained in this consumption report is correct to the best of my knowledge and
hereby request that my tax exempt permit be renewed for another season under the Fuel Oil Tax Act and undertake
to comply with the provisions of this Act and the Regulations thereunder.
Signature: ______________________________________________
Date: ______________________________
The personal information requested on this form is collected under the authority of and used for the purpose of administering the Fuel Oil Tax Act.
Questions about the collection or use of this information can be directed to the Yukon Department of Finance, Box 2703, Whitehorse, Yukon, Y1A
2C6, (867) 667-5343.
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