Arizona Form 5008 - Jet Fuel Tax Rate Adjustment Certificate

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Arizona Department of Revenue
ARIZONA FORM
5008
Jet Fuel Tax Rate Adjustment Certifi cate
This Certifi cate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009
and is to be used to claim the jet fuel tax rate adjustment as provided by A.R.S. § 42-5352.
This Certifi cate is to be completed by the purchaser and furnished to the vendor. The vendor shall retain this Certifi cate.
This Certifi cate must be renewed each calendar year. Incomplete Certifi cates are not valid.
Information
Information
By completion of this Certifi cate, the purchaser certifi es that it has purchased in excess of 10 million gallons of jet fuel in the calendar year enumer-
ated below.
Purchaser’s business Name and Address
Arizona Transaction Privilege Tax License Number
For calendar year January 1 - December 31, 20
Date purchaser reached 10 million gallons
Note: The purchaser shall retain adequate documentation substantiating its jet fuel purchases.
Certifi cate
Certifi cate
ARS § 42-5009 provides that if the purchaser cannot establish the accuracy and completeness of the information contained
ARS § 42-5009 provides that if the purchaser cannot establish the accuracy and completeness of the information contained
in this Certifi cate, the purchaser is liable in an amount equal to any tax, penalty or interest which the seller would have been
in this Certifi cate, the purchaser is liable in an amount equal to any tax, penalty or interest which the seller would have been
required to pay. Willful misuse of this certifi cate by the purchaser is a class 5 felony pursuant to ARS § 42-1127.B.2.
required to pay. Willful misuse of this certifi cate by the purchaser is a class 5 felony pursuant to ARS § 42-1127.B.2.
I, (print full name)
I, (print full name)
, hereby certify that the information on this
, hereby certify that the information on this
certifi cate is true, accurate and complete. Further, if purchasing as an agent, I certify that I am authorized to execute this
certifi cate is true, accurate and complete. Further, if purchasing as an agent, I certify that I am authorized to execute this
certifi cate on behalf of the purchaser named above.
certifi cate on behalf of the purchaser named above.
Signature of purchaser
Signature of purchaser
Date
Date
Title
Title
Print
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ADOR 60-2022 (6/07)

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