Publication 510 - Excise Taxes - 2004 Page 40
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48Model Certificate C
NOTIFICATION CERTIFICATE OF TAXABLE FUEL REGISTRANT
Name, address, and employer identification number of person receiving certificate
The undersigned taxable registrant (“Registrant”) hereby certifies under penalties of perjury that Registrant is registered by the Internal
Revenue Service with registration number
and that Registrant’s registration has not been revoked or suspended by the
Internal Revenue Service.
Registrant understands that the fraudulent use of this certificate may subject Registrant and all parties making such fraudulent use of
this certificate to a fine or imprisonment, or both, together with the costs of prosecution.
Signature and date signed
Printed or typed name of person signing
Title of person signing
Name of Registrant
Employer identification number
Address of Registrant
Page 40
ADVERTISEMENT
0 votes
Related Articles
Related forms
Excise Tax Report Form For Wholesale Liquor Excise Tax - Cobb County Business License Division
Financial
Publication 102 - Wisconsin Tax Treatment Of Tax-option (s) Corporations And Their Shareholders
Financial
Related Categories
Parent category: Financial