Form Ppt-4 - Export Certificate 1991
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1
2STATE OF NEW JERSEY
DIVISION OF TAXATION
PPT-4
(8-91)
PETROLEUM PRODUCTS GROSS RECEIPTS TAX
P.O. Box 269
Trenton, NJ 08646-0269
EXPORT CERTIFICATE
Name of buyer
Employer Identification Number
__________________________________________________________________________________________________
Address (number and street or rural route)
Buyer Information
__________________________________________________________________________________________________
City
State
Zip Code
This certificate is for:
Single sale – please complete the following:
Date of sale
Date of delivery
Type of petroleum
Number of gallons
Dollar amount of sale
Blanket certificate
CERTIFICATION OF BUYER
I __________________________________ certify that the petroleum
listed on this certificate is being purchased for immediate export to the
below stated facility outside the state for use outside this state. I agree to
make my books and records available to the New Jersey Division of
Taxation for audit so that it may verify that this petroleum was shipped
outside New Jersey for use outside the state.
Signature of buyer
Title
Date
Name of seller
__________________________________________________________________________________________________
Address (number and street or rural route)
Seller Information
__________________________________________________________________________________________________
City
State
Zip Code
Detail of Sale
Location of petroleum at time of sale:
Number
Street
City
State
Zip Code
Destination of Petroleum:
Delivered to buyer address
Other (enter name and address below)
Name
Number
Street
City
State
Zip Code
Method of transportation:
Truck/tank wagon
Barge
Tanker
Other _________________________
Transportation is operated by:
Buyer
Affiliate of buyer
Buyer’s customer
Other _________________________
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