CERTIFICATE OF PURCHASER OF CHEMICALS FOR EXPORT BY THE PURCHASER
(TO SUPPORT TAX-FREE SALES UNDER SECTION 4682(D)(3) OF THE INTERNAL REVENUE CODE.)
Effective Date _______________________________
Expiration Date _______________________________
(not more than one year
after effective date)
The undersigned purchaser (Purchaser) certifies the following under penalties of perjury:
Purchaser is registered with the Internal Revenue Service as a purchaser of ozone-depleting chemicals for export under registration number __________. Purchaser's registration has not been suspended or revoked by the Internal Revenue Service.
The following percentage of ozone-depleting chemicals purchased from:
_______________________________
(Name of seller)
_______________________________
(Address of seller)
_______________________________
(Taxpayer identifying number of seller)
are purchased for export by Purchaser.
Product | Percentage |
CFC-11 | __________ |
CFC-12 | __________ |
CFC-113 | __________ |
CFC-114 | __________ |
CFC-115 | __________ |
Halon-1211 | __________ |
Halon-1301 | __________ |
Halon-2402 | __________ |
Carbon tetrachloride | __________ |
Methyl chloroform | __________ |
Other (specify) | |
______________ | __________ |
This certificate applies to (check and complete as applicable):
______ All shipments to Purchaser at the following location(s):
_______________________________
_______________________________
_______________________________
______ All shipments to Purchaser under the following Purchaser account number(s):
_______________________________
_______________________________
_______________________________
______ All shipments to Purchaser under the following purchase order(s):
_______________________________
_______________________________
_______________________________
______ One or more shipments to Purchaser identified as follows:
_______________________________
_______________________________
_______________________________
Purchaser understands that Purchaser will be liable for tax imposed under section 4681 if Purchaser does not export the ODCs to which this certificate applies.
Purchaser understands that any use of the ODCs to which this certificate applies other than for export may result in the revocation of Purchaser's registration.
Purchaser will retain the business records needed to document the export of the ozone-depleting chemicals to which this certificate applies and will make such records available for inspection by Government officers.
Purchaser has not been notified by the Internal Revenue Service that its registration has been revoked or suspended.
Purchaser understands that the fraudulent use of this certificate may subject Purchaser and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution.
_______________________________
Name of Purchaser
_______________________________
Address of Purchaser
_______________________________
_______________________________
Taxpayer Identifying Number of Purchaser
_______________________________
Title of person signing
_______________________________
Printed or typed name of person signing
_______________________________
Signature
CERTIFICATE OF PURCHASER OF CHEMICALS FOR RESALE FOR EXPORT BY THE SECOND PURCHASER
(TO SUPPORT TAX-FREE SALES UNDER SECTION 4682(D)(3) OF THE INTERNAL REVENUE CODE.)
Effective Date _______________________________
Expiration Date _______________________________
(not more than one year
after effective date)
The undersigned purchaser (Purchaser) certifies the following under penalties of perjury:
Purchaser is registered with the Internal Revenue Service as a purchaser of ozone-depleting chemicals for export under registration number __________. Purchaser's registration has not been suspended or revoked by the Internal Revenue Service.
The following percentage of ozone-depleting chemicals purchased from:
_______________________________
(Name of seller)
_______________________________
(Address of seller)
_______________________________
(Taxpayer identifying number of seller)
will be resold by Purchaser to persons (Second Purchasers) that certify to Purchaser that they are (1) registered with the Internal Revenue Service as purchasers of ozone-depleting chemicals for export and (2) purchasing the ozone-depleting chemicals for export.
Product | Percentage |
CFC-11 | __________ |
CFC-12 | __________ |
CFC-113 | __________ |
CFC-114 | __________ |
CFC-115 | __________ |
Halon-1211 | __________ |
Halon-1301 | __________ |
Halon-2402 | __________ |
Carbon tetrachloride | __________ |
Methyl chloroform | __________ |
Other (specify) | |
______________ | __________ |
This certificate applies to (check and complete as applicable):
______ All shipments to Purchaser at the following location(s):
_______________________________
_______________________________
_______________________________
______ All shipments to Purchaser under the following Purchaser account number(s):
_______________________________
_______________________________
_______________________________
______ All shipments to Purchaser under the following purchase order(s):
_______________________________
_______________________________
_______________________________
______ One or more shipments to Purchaser identified as follows:
_______________________________
_______________________________
_______________________________
Purchaser understands that Purchaser will be liable for tax imposed under section 4681 if Purchaser does not resell the ODCs to which this certificate applies to a Second Purchaser for export or export those ODCs.
Purchaser understands that any use of the ODCs to which this certificate applies other than for resale to Second Purchasers for export may result in the revocation of Purchaser's registration.
Purchaser will retain the business records needed to document the sales to Second Purchasers for export covered by this certificate and will make such records available for inspection by Government officers. Purchaser also will retain and make available for inspection by Government officers the certificates of its Second Purchasers.
Purchaser has not been notified by the Internal Revenue Service that its registration has been revoked or suspended. In addition, the Internal Revenue Service has not notified Purchaser of the revocation or suspension of the registration of any Second Purchaser who will purchase ozone-depleting chemicals to which this certificate applies.
Purchaser understands that the fraudulent use of this certificate may subject Purchaser and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution.
_______________________________
Name of Purchaser
_______________________________
Address of Purchaser
_______________________________
_______________________________
Taxpayer Identifying Number of Purchaser
_______________________________
Title of person signing
_______________________________
Printed or typed name of person signing
_______________________________
Signature
26 C.F.R. §52.4682-5