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Page 2 of 2 FT-1000-A (9/11)

Instructions

General Information

on all subsequent deliveries the purchaser is given, within 10 days

of the applicable delivery, an invoice or other billing document

Seller

containing all of the information indicated in item b under Certification

The Tax Law provides that all diesel motor fuel is subject to the diesel

requirements.

motor fuel tax, the petroleum business tax, and the sales tax unless the

purchaser provides an exemption document.

Specific instructions

Use this certification upon receipt of an exemption document from the

Enter your name, address, NYS sales tax ID number, and NYS diesel

purchaser.

motor fuel tax registration number in the spaces provided. Also enter

the purchaser’s name, address, and NYS sales tax ID number (if

Do not use this certification for transactions that are not exempt from all

known). Indicate the date of purchase (or the date of the first purchase

three taxes; the NYS and local sales tax, the diesel motor fuel tax, and

if a blanket certification).

the petroleum business tax. For those transactions, use Form FT-1000,

Certificate of Prepayment or Payment of Taxes on Diesel Motor Fuel.

Mark an X in the applicable box, either Single-purchase certification

or Blanket certification. If this certification is to be used as certification

Definitions

of a single purchase, in the space entitled Product code, enter the

appropriate code from Publication 902 for the specific type of highway

Diesel motor fuel is No. 1 diesel fuel, No. 2 diesel fuel, biodiesel,

diesel motor fuel or non-highway diesel motor fuel you are selling.

kerosene, crude oil, fuel oil or other middle distillate and also motor fuel

suitable for use in the operation of an engine of the diesel type. It does

Basis of exemption

not include any product specifically designated as No. 4 diesel fuel.

Mark an X in the box that describes the type of exemption certificate

Non-highway diesel motor fuel is any diesel motor fuel that is

or document you were given. Mark box a if your sale is to a registered

designated for use other than on a public highway (except for the use

distributor of diesel motor fuel, mark box b if your sale is to an airline

of the public highway by farmers to reach adjacent lands), and is dyed

etc., mark box c if your the sale is to the United States or NYS or its

diesel motor fuel.

municipalities as described under Other transactions exempt from these

taxes.

Highway diesel motor fuel is any diesel motor fuel which is not

non-highway diesel motor fuel.

Interdistributor transactions —

Non-highway diesel motor fuel

may be sold untaxed between registered distributors of diesel motor

Dyed diesel motor fuel is diesel motor fuel which has been dyed in

fuel. Form FT-1001, Exemption Certificate for Diesel Motor Fuel

accordance with and for the purpose of complying with the provisions of

Interdistributor Transactions, is the exemption document the purchaser

25 USC 4082(a).

must give you to substantiate this exemption.

Certification requirements

Other transactions exempt from these taxes — If documentation

is required for other exempt transactions, you must be given the

On every sale of diesel motor fuel on which no diesel motor fuel excise

exemption document that applies explicitly to the exemption being

tax, petroleum business tax, or sales tax has been charged or passed

claimed: Form FT-1004, Certificate for Purchases of Non-Highway

through by the seller (other than for residential or commercial heating),

Diesel Motor Fuel or Residual Petroleum Product for Farmers and

the seller must give the purchaser, at or before the time of delivery of

Commercial Horse Boarding Operations, and Form FT-1020, Exemption

the fuel:

Certificate for Certain Taxes Imposed on Diesel Motor Fuel and

a properly completed Form FT-1000-A or photocopy; or

Propane.

an invoice or other billing document containing all of the following:

Organizations specifically exempt from the prepaid sales tax, diesel

date of sale

motor fuel tax, and the petroleum business tax are NYS or any of its

seller’s name and address

agencies, instrumentalities, public corporations, or political subdivisions

(counties, cities, towns, school districts, etc.); and the government

seller’s diesel motor fuel registration number

of the United States and any of its agencies or instrumentalities. A

purchaser’s name and address

government purchase order or contract is required as the exemption

type of diesel product

document to substantiate these exemptions.

either the statement, I certify that no state diesel motor fuel

This certification may be reproduced or may be incorporated into

tax, petroleum business tax, or sales tax is being charged

any invoice or other billing document if all the information on this

based on an exemption, or the alternative certification

certification (including the seller’s signature) is included.

language below.

Purchaser

Alternative certification language

Attach this certification to the invoice(s) or delivery ticket(s) covering

Since some distributors sell both taxable and exempt diesel motor

this purchase and keep these documents as part of your records for

fuel and may also sell motor fuel subject to certification requirements,

at least three years from the date of the last invoice covered by this

where certifications are required, the following language is acceptable

certificate.

and may be incorporated into the invoices or billing documents. This

language may be used in lieu of any other certification statements and

is considered acceptable certification language for invoices or billing

Need help?

documents issued in conjunction with sales of taxable diesel motor fuel,

exempt diesel motor fuel, and motor fuel:

Visit our Web site at

I certify that the amount of tax shown has been or will be paid by

(for information, forms, and online services)

me or my supplier and is being passed through. Where no state

diesel motor fuel excise tax, petroleum business tax, or sales

tax is shown for a particular diesel product, I certify that no such

Miscellaneous Tax Information Center:

(518) 457-5735

taxes are being charged on the product based on an exemption.

To order forms and publications:

(518) 457-5431

Blanket certification

Text Telephone (TTY) Hotline

Form FT-1000-A may be given as a blanket certification if:

(for persons with hearing and

speech disabilities using a TTY):

(518) 485-5082

a properly completed copy is given by the seller to the purchaser at

or before the time of the first delivery of diesel motor fuel on which no

taxes are charged; and

Form Ft-1000-A - Certification Of Exclusion Of Sales, Diesel Motor Fuel, And Petroleum Business Taxes From Selling Price Page 2

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