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Form Ft-1013 - Exemption Certification For Registered Retail Sellers Of Aviation Gasoline

New York State

FT-1013 (9/95)

Department of

Taxation

and Finance

To Sellers:

Your sales are subject to the

To Purchasers and Sellers:

applicable taxes on aviation

Read certiﬁcations carefully

gasoline unless the purchaser

Exemption Certiﬁcation for Registered

gives you a properly completed

before giving or accepting this

exemption document at or before

Retail Sellers of Aviation Gasoline

certiﬁcation. Read the

the time of delivery. Keep the

instructions on the back.

certiﬁcation for at least three

years.

The purchaser must complete this certiﬁcation and give it to the seller. Please type or print.

Name of seller

Name of purchaser

Street address

City

State

ZIP code

City

State

ZIP code

Seller’s New York State sales tax identiﬁcation number

Purchaser’s New York sales tax Identiﬁcation number

Seller’s New York State distributor of motor fuel identiﬁcation number

Purchaser’s New York State retail seller of aviation gasoline identiﬁcation number

□

Check the applicable box:

Single-purchase certiﬁcation

Blanket certiﬁcation

Unless this is marked above as a Single-purchase certiﬁcation, it will be considered part of any order given to the seller by

the purchaser and will remain in force until revoked by written notice.

Purchases of aviation gasoline

I am registered as a retail seller of aviation gasoline and I am purchasing aviation gasoline from a registered distributor of

motor fuel. All the aviation gasoline purchased under this certiﬁcation will be sold by me by delivery directly into the fuel

tanks of aircraft for use in the operation of such aircraft. (The aviation gasoline is exempt from the motor fuel tax but subject

to the prepaid sales tax and the petroleum business tax at the reduced rate for aviation gasoline.)

I certify that the aviation gasoline being purchased is exempt from the tax as indicated above.

Signature of purchaser or authorized representative

Title

Date

Any person who attempts to use this certiﬁcation to evade taxes due on aviation gasoline will be subject to penalties under

the New York State Tax Law.

Form Ft-1013 - Exemption Certification For Registered Retail Sellers Of Aviation Gasoline

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