Form Ft-1012 - Manufacturing Certification For Diesel Motor Fuel And Residual Petroleum Product

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Manufacturing Certification for
New York State
FT-1012
Department of
Diesel Motor Fuel and
(1/98)
Taxation
and Finance
Residual Petroleum Product
To Sellers:
Your sales are subject to the
applicable taxes on diesel motor
To Purchasers and Sellers:
fuel or residual petroleum product
Read certifications carefully before
unless the purchaser gives you a
properly completed certification at
giving or accepting this certificate.
or before the time of delivery. Keep
The purchaser must complete this certificate and give it to the seller. Please type or print.
the certificate for at least three years.
Name of vendor
Name of purchaser
Street address
Street address
City
State
ZIP code
City
State
ZIP code
Enter specific product type
and check applicable box:
□ Single-purchase certificate. Enter invoice or delivery ticket number
and number of gallons
.
□ Blanket certificate. This certificate will be considered part of any order given to you and will remain in force until revoked
by written notice. It covers only purchases of the specific product type listed below. (Use a separate Form FT-1012 for
each product type.)
Diesel Motor Fuel
(d) I certify that
% of the fuel is to be used for
residential heating purposes. (This sale is exempt from the
(a) I certify that all (100%) of the unenhanced diesel motor fuel
petroleum business tax, diesel motor fuel tax and the New York
covered by this certificate is being delivered to the manufacturing
State sales tax but, if applicable, subject to local sales tax).
site for use directly and exclusively in the production of tangible
(e) I certify that
% of the fuel is to be used for any
personal property for sale, by manufacturing, processing or
other purpose (except on the highways of this state) than that
assembly, and will not be consumed on the highways of this
stated above. (This sale is subject to the petroleum business tax
state. The fuel will not be delivered to a filling station or a tank
at the automotive rate, the diesel motor fuel tax and the New
equipped with a nozzle or other apparatus that can fuel a motor
York State and local sales taxes unless a valid exemption
vehicle. (This sale is exempt from the diesel motor fuel tax, the
document is completed and given to the supplier).
petroleum business tax, and the New York State and other local
sales taxes but, if fuel is delivered or used in New York City,
Residual Petroleum Product
subject to the 4% local sales tax.)
If less than 100% of the fuel is to be used for manufacturing
(a) I certify that all (100%) of the residual petroleum product
(as stated above) check the box below and indicate the
covered by this certificate is being delivered to the manufacturing
appropriate percentages of use. These percentages must
site for use directly and exclusively in the production of tangible
total 100%.
personal property for sale, by manufacturing, processing or
assembly, and will not be consumed on the highways of this
state. (This sale is exempt from the petroleum business tax and
(a) I certify that
% of the fuel is to be used in
the New York State and other local sales taxes but, if fuel is
the production of tangible personal property for sale as described
delivered or used in New York City, subject to the 4% local sales
above (must be supported by an engineering study).
tax.)
If less than 100% of the product is to be used for
manufacturing (as stated above) check the box below and
(b) I certify that
% of the fuel is to be used for
indicate the appropriate percentages of use. These
nonresidential (commercial) heating purposes. (This sale is
percentages must total 100%.
subject to the petroleum business tax at the commercial
gallonage rate for diesel motor fuel and the New York State and
(a) I certify that
% of the product is to be used in
local sales taxes, but exempt from the diesel motor fuel tax.)
the production of tangible personal property for sale as described
above (must be supported by an engineering study).
(c) I certify that
% of the fuel is to be used in the
(b) I certify that
% of the product is to be used for
production of (a) tangible personal property for sale, by refining,
residential heating purposes. (This sale is exempt from the
extracting or mining or (b) gas, electricity (except if you are an
petroleum business tax and the New York State sales tax but, if
electric utility using the fuel in generators to produce electricity),
applicable, subject to local sales tax).
refrigeration or steam for sale. The fuel will not be delivered to a
filling station or a storage tank equipped with a nozzle or other
(c) I certify that
% of the product is to be used for
apparatus that can fuel a motor vehicle or be used on the
any other purposes than that stated above except if you are an
highways of this state. (This sale is subject to the petroleum
electric utility using the product in generators to produce
business tax at the commercial gallonage rate for diesel motor
electricity. (This sale is subject to the petroleum business tax at
fuel and, if delivered or used in New York City, the 4% local sales
the commercial gallonage rate for residual petroleum product and
tax, but exempt from the diesel motor fuel tax and the New York
to the New York State and local sales taxes unless a valid
State and other local sales taxes.)
exemption document is completed and given to the supplier).
Note: Kerosene is exempt from the petroleum business tax when sold by a petroleum business registered as a Distributor of Diesel
Motor Fuel or a Retailer of Heating Oil Only and the kerosene is not mixed or blended with other products, is not sold in conjunction
with any other petroleum product, or is not sold or used to operate motor vehicles.
I certify that the diesel motor fuel or residual petroleum product being purchased will be used as indicated.
Signature of purchaser or authorized representative
Title
Date
Any person who attempts to use this certificate to evade taxes due on diesel motor fuel or residual petroleum product will be subject to
penalties under the NYS Tax Law.

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