STATE OF NEW JERSEY
MFT-13
DIVISION OF TAXATION
(08-04)
MOTOR FUELS TAX
PO BOX 243
Trenton, NJ 08646-0243
EXPORT CERTIFICATE
Name of buyer
Exporter License Number
Address (number and street or rural route)
Buyer
Information
City
State
Zip
This Certificate is for:
Single sale - Please complete the following:
Date of sale
Date of delivery
Type of petroleum
Number of gallons
Dollar amount of sale
Blanket certificate - Complete Schedule A on page 2 (two)
CERTIFICATE OF BUYER
I ________________________ certify that the motor fuel listed on this certificate is
being purchased for immediate export to the below stated facility outside the state
for use outside of this state. I agree to make my books and records available to the
New Jersey Division of Taxation for audit so that it may verify that this petroleum
was shipped outside New Jersey for the use outside the state.
_______________________________________________________________
Signature of buyer
Title
Date
Name of seller
Employer ID #
Motor Fuel License #
Address (number and street or rural route)
Seller
Information
City
State
Zip Code
Detail of Sale
Location of motor
Number
Street
City
State
Zip Code
fuel at time of sale:
Delivered to buyer address
Other (enter name and address below)
Destination of Petroleum:
Name
Number
Street
City
State
Zip
Truck/tank wagon
Barge
Tanker
Other _______________
Method of Transportation:
Buyer
Affiliate of buyer
Buyer’s customer
Other _____________
Transportation is operated by: