Form Otr-308a - Exemption Application And Certificate For Purchasers Of Gas Used In A Restaurant

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GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer
Office of Tax and Revenue
Exemption Application and Certificate for Purchasers of Gas Used in a Restaurant
A. This form will serve as both the application for and certificate of exemption from sales tax. Please keep a copy of this
form for your records.
B. This form is to be used to claim the sales tax exemption for gas used in a restaurant only.
C. “Restaurant” includes pizzerias, delicatessens, ice cream parlors, cafeterias, take-out counters and caterers.
“Restaurant” does not include beverage counters such as, coffee shops and juice bars.
D. The restaurant must be separately-metered in order to receive the exemption. For example, a restaurant located in a
hotel cannot share the same utility meter as the hotel itself.
E. Purchasers of gas used directly in a restaurant should complete this form and mail to Washington Gas and Light Co.
F. Washington Gas and Light Co. shall verify the information in this form and reflect the exemption on the purchaser’s
account for bills rendered after the date of receipt.
Utility Provider:
Washington Gas Light Co.
Billing Department
6801 Industrial Rd
Springfield, VA 22151
Restaurant / Purchaser:
Purchaser and trade name_____________________________________________________________________
Federal Employer Identification number_________________________________________________________
Street address______________________________________________________________________________
City, state & zip____________________________________________________________________________
Type of Utility: Gas
Meter number_______________________________Account number__________________________________
Certification:
I HEREBY CERTIFY under the penalties of perjury that the gas for this account will be consumed directly by a
restaurant that is separately-metered.
________________________________
__________________________________
Signature
Print name
________________________________
__________________________________
Date
Telephone number
OTR-308A (REV 4/10)

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