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New York State Department of Taxation and Finance

PT-303

Railroad Exemption Certificate

(6/03)

for Diesel Motor Fuel

Purchasers and sellers: Read instructions and certification carefully before giving or accepting this certificate.

Sellers: Your sales are subject to the petroleum business tax at the automotive-type diesel motor fuel rate, unless the purchaser gives you a

properly completed certificate at or before the time of delivery. Keep this certificate for at least three years.

Purchasers: You must complete this certificate and give it to the seller. Please type or print.

Name of seller

Name of purchaser

Street address

City

State

ZIP code

City

State

ZIP code

New York State diesel motor fuel registration number

Purchaser’s certificate of authority number

Check applicable box:

Single-purchase certificate

Date of delivery

Invoice or delivery ticket number

Gallons purchased or sold

Blanket certificate — will be considered part of any order given to the seller and will remain in force until revoked by written notice.

I, the undersigned, do hereby certify that the diesel motor fuel covered by this certificate will be used only to fuel locomotives or other

self-propelled rolling stock that runs only on rails. The fuel is being delivered into a storage tank not equipped with a nozzle designed to fuel

a motor vehicle or delivered directly into locomotives or other self-propelled rolling stock that runs only on rails. (My purchase of diesel

motor fuel is subject to the petroleum business tax at the railroad diesel rate and, unless otherwise exempt, is subject to New York

State diesel motor fuel tax and to state and local sales taxes.)

I hereby certify that the diesel motor fuel being purchased will be delivered and used as stated above.

Signature of purchaser or authorized representative

Title

Date

Any person who attempts to use this form to evade taxes due on diesel motor fuel will be subject to penalties as provided by the New York

State Tax Law. Under section 1812-f(1), this person shall be guilty of a misdemeanor; however, if the tax liability evaded is equal to or greater

than $1,000, such person would be guilty of a class E felony.

General information

Need help?

A person may purchase diesel motor fuel at the railroad diesel rate

by giving this properly completed certificate to a registered

Internet access:

distributor of diesel motor fuel. All the fuel must be used only to fuel

(for information, forms, and publications)

locomotives or other self-propelled rolling stock that runs only on

rails. The seller must deliver the diesel motor fuel directly into the

Fax-on-demand forms: 1 800 748-3676

locomotives or other self-propelled rolling stock. If the seller

delivers the diesel motor fuel into a storage tank, the tank must not

Telephone assistance is available from 8:00

to 5:00

A.M.

P.M.

(eastern time), Monday through Friday.

be equipped to fuel motor vehicles.

To order forms and publications:

1 800 462-8100

The distributor must keep this certificate for at least three years

Business Tax Information Center:

1 800 972-1233

after the date of the last sale covered by the certificate.

From areas outside the U.S. and outside Canada:

(518) 485-6800

Instructions

Hearing and speech impaired (telecommunications device for the deaf

The purchaser must give this certificate to the seller at or before

(TDD) callers only): 1 800 634-2110 (8:00

to 5:00

eastern time).

A.M.

P.M.

the first sale of diesel motor fuel covered by this certificate.

Persons with disabilities: In compliance with the Americans with

Disabilities Act, we will ensure that our lobbies, offices, meeting

The purchaser may check either the blanket certificate box in which

rooms, and other facilities are accessible to persons with disabilities.

case this certificate may be used to cover all subsequent sales

If you have questions about special accommodations for persons

until revoked in writing by the purchaser, or the purchaser may

with disabilities, please call 1 800 972-1233.

check the single-purchase certificate box in which case a separate

If you need to write, address your letter to: NYS Tax Department,

certificate must be given for each subsequent sale.

Business Tax Information Center, W A Harriman Campus, Albany NY 12227.

The purchaser or an authorized representative of the purchaser

must sign this certificate.

Form Pt-303 - Railroad Exemption Certificate For Diesel Motor Fuel - New York State Department Of Taxation And Finance

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