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EXEMPTION CERTIFICATE

Taylor Oil Co., Inc.
77 Second Street, P.O. Box 974
Somerville, New Jersey 08876
908-725-7737
Fax 908-725-7746

The following form of exemption certificate is acceptable and must be adhered to in substance.

Date ________________________________________

The undersigned purchaser (Purchaser) hereby certifies that —

(check applicable type of certificate)

The diesel or aviation fuel specified in the accompanying order, or on the reverse side hereof

(or)

All fuel ordered by the Purchaser for a period beginning on ________________________________ and ending ________________________________
(period not to exceed 12 calendar months)
will be used for the following tax-exempt or tax-reduced purposes.

(1) Use as a fuel in a school bus or qualified local bus

(2) Use as a fuel in a local or inter-city bus (other than a school bus or a qualified local bus)

(3) Use as a fuel in a "non-taxable use" as that term is defined in section 6427 (1) (2) of the

Internal Revenue Code (Such uses include off-highway business uses and use on a farm for farming purposes).

"If this taxable fuel is resold or used for a purpose other than as stated in this certificate, the Purchaser may be subject to tax.

"Purchaser will be prepared to establish by satisfactory evidence the purpose for which Purchaser used the product bought under this certification.

"Purchaser understands that any fraudulent use of this certification to buy any taxable fuel free of tax or at a tax reduced rate may subject Purchaser to penalties of perjury, which may include fine or imprisonment.

 

Federal I.D. Number _________________________________________________

Signature ___________________________________________________________

Title ________________________________________________________________

Address ___________________________________________________________

____________________________________________________________________

COMPANY NAME _________________________________________________