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FT-1020

New York State Department of Taxation and Finance

Exemption Certificate for Certain Taxes

(9/11)

Imposed on Diesel Motor Fuel and Propane

Purchasers and sellers: Read certifications carefully before giving or accepting this certificate.

This certificate must be completed by the purchaser and given to the seller

. Print or type.

(see instructions)

Name of purchaser

Name of seller

Address

(number and street)

City

State

ZIP code

City

State

ZIP code

Purchaser’s Certificate of Authority number

Seller’s Certificate of Authority number

Specific product type :

. (Use a separate Form FT-1020 for each product type.)

Single-purchase certificate – enter the invoice or delivery ticket number

, and number of gallons

Blanket certificate – will be considered part of any order given to you and will remain in force until revoked by written notice. This certificate covers only

purchases of the specific product type indicated above.

All transactions listed in Parts 1, 2, and 3 are taxable (or exempt) as indicated

(see instructions).

Part 1 — Purchases of kero-jet fuel

This is an airline that is registered as an aviation fuel business under Article 13-A with registration number

; or

an airline registered under Article 12-A as a distributor of diesel motor fuel or as a distributor of kero-jet fuel only, with registration

number

. The kero-jet fuel is for use in airplanes owned or controlled by this airline and is being purchased

from (mark an X in one):

a person registered under Article 12-A as a distributor of diesel motor fuel or as a distributor of kero-jet fuel only (exempt from the diesel motor fuel

tax, the petroleum business tax, and New York State (NYS) and local sales tax); or

a person not registered as above (subject to the petroleum business tax; exempt from the diesel motor fuel tax and NYS and local sales tax).

This is an airline that is not registered as an aviation fuel business, or as a distributor of diesel motor fuel, or as a distributor of kero-jet fuel only. The

kero-jet fuel is for use in airplanes owned or controlled by this airline (subject to the petroleum business tax; exempt from the diesel motor fuel tax and

NYS and local sales tax).

This is not an airline. It is registered under Article 13-A as an aviation fuel business, or as a distributor of diesel motor fuel, or as a distributor of kero-jet

fuel only. The fuel, which is being delivered directly into the fuel tank of an aircraft owned or controlled by this business, is being purchased from

(mark an X in one):

a distributor of kero-jet fuel only (subject to NYS and local sales tax; exempt from the diesel motor fuel tax and the petroleum business tax); or

a distributor of diesel motor fuel (subject to NYS and local sales tax and the diesel motor fuel tax; exempt from the petroleum business tax).

This is not an airline and it is not registered as an aviation fuel business, or as a distributor of diesel motor fuel, or as a distributor of kero-jet fuel only.

This business is purchasing the fuel from a distributor of kero-jet fuel only that delivers the fuel directly into the fuel tank of an airplane owned by this

business (subject to NYS and local sales tax and the petroleum business tax; exempt from the diesel motor fuel tax).

Part 2 — Purchases of propane or water-white kerosene

I am a registered vendor purchasing propane for resale. The propane is not designated or destined for use as motor fuel. I will collect any applicable tax

on the final sale (exempt from the motor fuel tax, the petroleum business tax, and NYS and local sales tax).

I am a registered vendor purchasing water-white kerosene for resale that I will resell exclusively for heating purposes in quantities of 20 gallons or less

(exempt from the diesel motor fuel tax, the petroleum business tax, and NYS and local sales tax).

Part 3 — Purchases of non-highway diesel motor fuel for use in production

I am a registered vendor purchasing non-highway diesel motor fuel for use directly and exclusively in the production of gas, electricity, refrigeration, or

steam for sale. It will not be delivered into a storage tank equipped to dispense fuel into the fuel tank of a motor vehicle or used on the public highways of

NYS (subject to the petroleum business tax at the commercial gallonage rate and, if delivered or used in New York City, the New York City local sales tax,

but exempt from the diesel motor fuel tax and NYS and other local sales tax).

I am a registered vendor purchasing non-highway diesel motor fuel for use directly and exclusively in the production of tangible personal property for

sale by refining, mining, or extracting. It will not be delivered into a storage tank equipped to dispense fuel into the fuel tank of a motor vehicle or used on

the public highways of this state (subject to the petroleum business tax at the commercial gallonage rate, but exempt from the diesel motor fuel tax and

NYS and local sales tax).

Signature

I certify that the above statements are true and complete, and I make these statements with the knowledge that willfully issuing a false or fraudulent certificate

with the intent to evade tax is a misdemeanor under New York State Tax Law sections 1812(c)(4), 1812-f(c)(4), and 1817(m) and Penal Law section 210.45,

punishable by a fine up to $10,000 for an individual or $20,000 for a corporation. I also understand that the Tax Department is authorized to investigate the

validity of exemptions claimed or the accuracy of any information entered on this form.

Signature of purchaser or authorized representative

Title

Date