Certificate of Person Buying Compressed Natural Gas (CNG) for a Nontaxable Use
(To support tax-free sales of CNG under section 4041 of the Internal Revenue Code.)
_______________________________
_______________________________
Name, address, and employer identification number of seller
____________________ ("Buyer") certifies the following under penalties of perjury:
The CNG to which this certificate relates will be used in a nontaxable use.
This certificate applies to the following (complete as applicable):
If this is a single purchase certificate, check here ______ and enter:
1. Invoice or delivery ticket number ________________
2. ________ (number of MCFs) ________
If this is a certificate covering all purchases under a specified account or order number, check here ______ and enter:
1. Effective date ________________
2. Expiration date ________________ (period not to exceed 1 year after the effective date)
3. Buyer account or order number ________________
Buyer will not claim a credit or refund under section 6427 of the Internal Revenue Code for any CNG to which this certificate relates.
Buyer will provide a new certificate to the seller if any information in this certificate changes.
Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's right to provide a certificate.
Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. In addition, the Internal Revenue Service has not notified Buyer that the right to provide a certificate has been withdrawn from a purchaser to which Buyer sells CNG tax free.
Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making any fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution.
_______________________________
Printed or typed name of person signing
_______________________________
Title of person signing
_______________________________
Employer identification number
_______________________________
Address of Buyer
_______________________________
Signature and date signed
26 C.F.R. §48.4041-21