Form 2992 - Fuel Tax Exemption Certificate - Sales To U.s. Government
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1MISSOURI DEPARTMENT OF REVENUE
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TAXATION DIVISION
FORM
P.O. BOX 300, JEFFERSON CITY, MO 65105-0300
2992
(573) 751-2611 TDD (800) 735-2966
FUEL TAX EXEMPTION CERTIFICATE —
(REV. 03-2013)
SALES TO U.S. GOVERNMENT
Fuel retailers in Missouri making sales to the U.S. Government may make such sales without charging fuel tax if the retailer has obtained a
signed exemption certificate. This certificate must be maintained in the retailer’s files and must be updated every three years.
SELLER’S NAME
FEIN OR SOCIAL SECURITY NUMBER
TELEPHONE NUMBER
(_ _ _) _ _ _ - _ _ _ _
__ __ __ __ __ __ __ __ __
SELLER’S ADDRESS
P.O. BOX
CITY
STATE
ZIP
__ __ __ __ __
PURCHASER’S NAME
FEIN OR SOCIAL SECURITY NUMBER
TELEPHONE NUMBER
__ __ __ __ __ __ __ __ __
(_ _ _) _ _ _ - _ _ _ _
PURCHASER’S ADDRESS
P.O. BOX
CITY
STATE
ZIP
__ __ __ __ __
MOTOR FUEL SOLD TO U.S. GOVERNMENT
Government Agency Name ____________________________________________________________
Exempt Use ________________________________________________________________________
This Exemption is for:
All motor fuel purchased
__________________ Gallons
I hereby certify, under penalty of perjury, that the motor fuel purchased will be used in the exempt manner stated above and
defined by the statute quoted below. The invoice or sales slip for each individual purchase claimed under this exemption
certificate will be signed and dated and such exemption will be updated every three years with the retailer.
I further certify under penalty of perjury that if any of the motor fuel on said invoice or sales slip is not used as certified
above, which will make such fuel subject to the motor fuel tax, I will so notify the seller and pay the tax thereon. Should I not
so notify the seller, then I am liable for tax, penalty and interest on such purchase, pursuant to the provisions of Chapter 142,
RSMo.
I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that
I am not eligible for any tax exemption, credit or abatement if I employ such aliens.
NAME OF AUTHORIZED PURCHASER OR PURCHASER’S AGENT (PLEASE PRINT)
SIGNATURE
DATE (MM/DD/YYYY)
__ __ / __ __ / __ __ __ __
GENERAL INSTRUCTIONS:
This exemption certificate must be completed and maintained in the retailer’s files to substantiate sales made to the U.S.
Government.
Missouri law, Section 142.815.2(3), RSMo, allows exempt sales to the U.S. Government. The seller must obtain a signed
exemption certificate from the purchaser (U.S. Government). The signed certificate must be maintained by the retailer, and
must be updated every three years. The retailer must keep the original, signed certificate in its files to support sales made
without state fuel tax. A copy of the certificate may be given to the customer or purchaser.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or e-mail excise@dor.mo.gov.
You may also access the Department’s web site at
to obtain this form.
DOR-2992 (03-2013)
For more information, visit
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