Form Au-302 - Farmer Declaration Motor Vehicle Fuels Tax Exemption printable pdf download

Form Au-302 - Farmer Declaration Motor Vehicle Fuels Tax Exemption

Form AU-302

Department of Revenue Services

State of Connecticut

Farmer Declaration

25 Sigourney Street

Hartford CT 06106-5032

Motor Vehicle Fuels Tax Exemption

(Rev. 05/06)

Statutory Authority: Conn. Gen. Stat. §12-458(a)(3)(G)

I am over eighteen years of age.

I have been issued R657, Farmer Tax Exemption Permit, by the Department of Revenue

Services (DRS). If the permit is not issued to me as a sole proprietor, but is issued to a

corporation, partnership, limited liability, or any other type of business entity, I have the authority

to execute this declaration on behalf of the business entity.

R657, referenced above, is currently in effect. I have attached a copy of the permit to this declaration.

I am purchasing fuel that will be used exclusively for farming purposes. The fuel being purchased

will not be used in motor vehicles registered or required to be registered to operate upon the public

highways unless the fuel is used in motor vehicles registered and used exclusively for farming

purposes.

The fuel being purchased will not be delivered to a tank in which I keep fuel both for farm and for

personal use.

Declaration: I declare under penalty of law that I have examined this declaration (including any

accompanying schedules and statements) and, to the best of my knowledge and belief, it is true, complete,

and correct. I understand that the penalty for willfully delivering a false declaration to DRS is a fine of not

more than $5,000, or imprisonment for not more than five years, or both. The declaration of a paid

preparer other than the taxpayer is based on all information of which the preparer has any knowledge.

Signature: ____________________________ Print Name: ______________________________

Title: _________________________________ Date: ___________________________________

Provide this declaration to the distributor and retain a copy for your records.

Form Au-302 - Farmer Declaration Motor Vehicle Fuels Tax Exemption