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Page 2 of 2 FT-937 (9/11)

Instructions

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be purchasing fuel for use in firefighting vehicles,

How to use this certificate

apparatus or equipment, or emergency rescue or first

This certificate must be completed by the purchaser and

aid response vehicles, apparatus or equipment, that are

given to each supplier of motor fuel or diesel motor fuel

owned and operated by the fire companies or ambulance

at the time of the first purchase of fuel from the supplier.

services.

A separate certificate is not necessary for each additional

Volunteer fire companies and volunteer ambulance services

purchase, provided the hospital, volunteer fire company

must pay the New York State motor fuel tax and diesel

or ambulance service name, address and Form ST-119,

motor fuel tax (excise taxes) at the time of purchase, but

Exempt Organization Certificate, number appears on the

may be entitled to a refund of the excise taxes.

sales slip, billing invoice or delivery ticket. This certificate

is considered part of each order given to the supplier and

Vendors must keep this certificate for at least 3 years after

remains in force until revoked by the purchaser.

the date of the last sale substantiated by the certificate.

Who may use this certificate

This certificate may be used only when a hospital, volunteer

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fire company or ambulance service is the direct purchaser

and payer of record. Any bill, invoice or receipt given by a

Internet access:

vendor must show the hospital, volunteer fire company or

(for information, forms, and publications)

ambulance service as the purchaser. Payment must be from

the funds of the exempt organization.

Telephone assistance

Note: The exemption from the motor fuel tax and the

state and local sales and use tax on motor fuel and diesel

Miscellaneous Tax Information Center: (518) 457-5735

motor fuel does not extend to subordinate or affiliated

To order forms and publications:

(518) 457-5431

units, officers, members or employees of the hospital, fire

company or ambulance service.

Text Telephone (TTY) Hotline (for persons with hearing

and speech disabilities using a TTY): If you have

access to a TTY, contact us at (518) 485-5082.

Part 1 — Hospitals

If you do not own a TTY, check with independent

living centers or community action programs to find

To qualify for exemption from the state and local sales and

out where machines are available for public use.

use tax and motor fuel tax on purchases of motor fuel, the

hospital must:

Persons with disabilities: In compliance with the

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hold a current operating certificate issued by either

Americans with Disabilities Act, we will ensure

that our lobbies, offices, meeting rooms, and other

the New York State Department of Health under

facilities are accessible to persons with disabilities. If

Section 2805 of the Public Health Law or the New York

you have questions about special accommodations

State Department of Mental Hygiene pursuant to the

for persons with disabilities, call the information

authority of Article 31 of the Mental Hygiene Law, and

center.

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be qualified as an exempt organization under

Tax Law section 1116(a)(4) and hold a valid Form ST-119,

Exempt Organization Certificate, issued by the New York

State Department of Taxation and Finance, Taxpayer

Guidance Division.

Part 2 — Volunteer fire companies or volunteer

ambulance services

To qualify for exemption from the state and local sales and

use tax on motor fuel or diesel motor fuel, volunteer fire

companies or ambulance services must:

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be a fire company or fire department, as defined in

section 3 of the volunteer firefighters benefit law, or a

volunteer ambulance service as defined in section 3001 of

the public health law, and

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be qualified as an exempt organization under Tax Law

section 1116(a)(4) and hold a valid Form ST-119, Exempt

Organization Certificate, issued by the New York State

Department of Taxation and Finance, Taxpayer Guidance

Division, and

Form Ft-937 - Certificate Of Exemption For Qualified Hospitals, Volunteer Fire Companies And Volunteer Ambulance Services Page 2

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