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Page 2 of 2 FT-1012 (6/12)

Part 4 — Residual petroleum product

(If less than 100% of the product is to be used for manufacturing as stated

above, check this box and indicate the appropriate percentages (must total 100%) of use.)

I certify that

% of the product is to be used in the production of tangible personal property for sale as described above (must

be supported by an engineering study).

I certify that

% of the product is to be used for residential heating purposes. (This sale is exempt from the petroleum business

tax and the New York State sales tax but, if applicable, subject to local sales tax.)

I certify that

% of the product is to be used for nonresidential (commercial) heating purposes. (This sale is subject to the

petroleum business tax at the nonresidential heating rate for residual petroleum product and to the New York State and local sales taxes.)

I certify that

% of the product is to be used for any other purposes than that stated above except if you are a rate-regulated

electric corporation using the product in generators to produce electricity. (This sale is subject to the petroleum business tax at the

commercial gallonage rate for residual petroleum product and to the New York State and local sales taxes, unless a valid 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 non-highway diesel motor fuel only and the kerosene is not mixed or blended with other products, is not sold with any other petroleum product, or

is not sold or used to operate motor vehicles or delivered into a tank equipped with a nozzle.

Certification: I certify that the above statements are true and complete, and I make these statements with the knowledge that willfully issuing a false

or fraudulent certificate with the intent to evade tax is a misdemeanor under New York State Tax Law sections 1812(c)(4), 1812-f(c)(4), and 1817(m)

and Penal Law section 210.45, punishable by a fine up to $10,000 for an individual or $20,000 for a corporation. I also understand that the Tax

Department is authorized to investigate the validity of exemptions claimed or the accuracy of any information entered on this form.

Signature of purchaser or authorized representative

Title

Date

Instructions

General information

Dyed diesel motor fuel means diesel motor fuel which has been dyed in

accordance with and for the purpose of complying with the provisions

This certificate can be used to claim exemption from the taxes (the

of 26 USC 4082(a).

petroleum business tax, diesel motor fuel tax, and sales and use tax)

Residual petroleum product is the topped crude of refinery operations

on non-highway diesel motor fuel and residual petroleum product

as indicated on the front. You may use it for a single purchase or for

including No. 5 fuel oil, No. 6 fuel oil, bunker C, and that special grade

of diesel product designated No. 4 diesel fuel, that is not suitable

blanket purchases of one specific type of product.

for use in the operation of a motor vehicle engine. This product is

This certificate may not be used to purchase fuel for use in farm

sometimes used for the production of electric power, space heating,

production; use Form FT-1004, Certificate for Purchases of

vessel bunkering, and other industrial purposes.

Non-Highway Diesel Motor Fuel or Residual Petroleum Product for

Farmers and Commercial Horse Boarding Operations.

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Directly means the fuel must, during the production phase of a

process, operate exempt production machinery or equipment, or

Visit our Web site at

create conditions necessary for production, or perform an actual part

• get information and manage your taxes online

of the production process.

• check for new online services and features

Exclusively means that all of the fuel is used entirely (100%) in the

production process.

Telephone assistance

Production includes the production line of the plant, starting with the

Miscellaneous Tax Information Center:

(518) 457-5735

handling and storage of raw materials at the plant site and continuing

through the last step of production where the product is finished and

To order forms and publications:

(518) 457-5431

packaged for sale.

Text Telephone (TTY) Hotline (for persons with

Manufacturing means the production of tangible personal property that

hearing and speech disabilities using a TTY):

(518) 485-5082

has a different identity from its ingredients.

Persons with disabilities: In compliance with the

Processing means the performance of any service on tangible personal

Americans with Disabilities Act, we will ensure that our

property that changes the nature, shape, or form of the property.

lobbies, offices, meeting rooms, and other facilities are

Assembly means the coupling or the uniting of parts or materials as

accessible to persons with disabilities. If you have questions

a manufacturing process or a step in the manufacturing process that

about special accommodations for persons with disabilities, call

results in a new product.

the information center.

Diesel motor fuel means No. 1 diesel fuel, No. 2 diesel fuel, biodiesel,

kerosene, fuel oil or other middle distillate and also motor fuel suitable

for use in the operation of an engine of the diesel type. It does not

include any product specifically designated No. 4 diesel fuel.

Non-highway diesel motor fuel means any diesel motor fuel that is

designated for use other than on a public highway (except for the use

of the public highway by farmers to reach adjacent lands), and is dyed

diesel motor fuel.

Highway diesel motor fuel means any diesel motor fuel which is not

non-highway diesel motor fuel.

Form Ft-1012 - Manufacturing Certification For Non-Highway Diesel Motor Fuel And Residual Petroleum Product Page 2

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