Form Rev 26 - Washington Seller'S Business And Occupation Tax Foreign Fuel Exemption Certificate

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S
’
B
A
O
T
ELLER
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USINESS
ND
CCUPATION
AX
F
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E
C
OREIGN
UEL
XEMPTION
ERTIFICATE
RCW 82.04.433, WAC 458-20-175
Seller
Vessel Name
Street Address
City
State
Zip Code
To be Completed and Signed by the Purchaser or Their Agent
We hereby certify that this purchase of _______________________ from ______________________ will
(seller)
(type and amount of fuel)
be consumed as fuel outside the territorial waters of the United States by the vessel named above. We
further certify that this vessel is used primarily in foreign commerce and that none of the fuel purchased will
be consumed within the territorial boundaries of the state of Washington.
Purchaser’s Name
Purchaser’s Agent
Date
Agent’s Signature
Title or Office
To be Completed and Signed by the Seller or Their Agent
I, _____________________, certify that to the best of my knowledge, the provided information contained in
this certificate is accurate.
Seller's Representative's Signature
Date
S
P
R
T
F
F
Y
R
ELLER
LEASE
ETAIN
HIS
ORM
OR
OUR
ECORDS
For tax assistance visit or call 1-800-647-7706. To inquire about the availability of this document in an alternate
format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.
REV 26 0016 (08/17/04)

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