Form Ft-123 - Ida Agent Or Project Operator Exempt Purchase Certificate For Fuel

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New York State Department of Taxation and Finance
New York State Taxes on Fuel (Articles 12-A, 13-A, 28, and 29)
IDA Agent or Project Operator
Exempt Purchase Certificate for Fuel
This certificate is not valid unless all entries have been completed.
To be completed by the purchaser and given to the seller.
Name of seller
Name of agent or project operator
Street address
Street address
City, town, or village
ZIP code
City, town, or village
ZIP code
Agent or project operator sales tax ID number
(see instructions)
Single-purchase certificate
Blanket-purchase certificate (valid only for the project listed below)
Mark an X in one:
To the seller:
You must identify the project on each bill and invoice for such purchases and indicate on the bill or invoice that the IDA or agent
or project operator of the IDA was the purchaser.
Project information
I certify that I am a duly appointed agent or project operator of the named IDA and that I am purchasing the fuel for use in the following
IDA project and that such purchases qualify as exempt from excise taxes and sales and use taxes under my agreement with the IDA.
Name of IDA
Name of project
IDA project number
(use OSC number)
Street address of project site
City, town, or village
ZIP code
Enter the date that you were appointed agent or
Enter the date that agent or project operator
project operator
status ends
Only fuel or residual petroleum product used to complete the project may be purchased by IDA agents or
Exempt purchases –
project operators exempt from the fuel excise tax, petroleum business tax, and sales and use tax. Fuel or residual petroleum product
used to operate a business after the project is completed does not qualify for this exemption (see instructions).
Mark an X in boxes that apply:
C. Non-highway diesel motor fuel
A. Motor fuel
B. Highway diesel motor fuel
D. Residual petroleum product
Certification: I certify that the above statements are true, complete, and correct, and that no material information has been omitted.
I make these statements and issue this exemption certificate with the knowledge that this document provides evidence that excise
taxes and state and local sales or use taxes do not apply to a transaction or transactions for which I tendered this document and that
willfully issuing this document with the intent to evade any such tax may constitute a felony or other crime under New York State Law,
punishable by a substantial fine and a possible jail sentence. I understand that this document is required to be filed with, and delivered
to, the vendor as agent for the Tax Department for the purposes of Tax Law section 1838 and is deemed a document required to be
filed with the Tax Department for the purpose of prosecution of offenses. I also understand that the Tax Department is authorized to
investigate the validity of tax exclusions or exemptions claimed and the accuracy of any information entered on this document.
Signature of purchaser or purchaser’s representative
(include title and relationship)
Type or print the name, title, and relationship that appear in the signature box


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