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Irs Form 1040nr

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Irs Form 1040nr

Irs form 1040nr Publication 597 - Introductory Material Table of Contents Introduction Introduction This publication provides information on the income tax treaty between the United States and Canada. Irs form 1040nr It discusses a number of treaty provisions that often apply to U. Irs form 1040nr S. Irs form 1040nr citizens or residents who may be liable for Canadian tax. Irs form 1040nr Treaty provisions are generally reciprocal (the same rules apply to both treaty countries). Irs form 1040nr Therefore, a Canadian resident who receives income from the United States may refer to this publication to see if a treaty provision may affect the tax to be paid to the United States. Irs form 1040nr This publication does not deal with Canadian income tax laws; nor does it provide Canada's interpretation of treaty articles, definitions, or specific terms not defined in the treaty itself. Irs form 1040nr The United States—Canada income tax treaty was signed on September 26, 1980. Irs form 1040nr It has been amended by five protocols, the most recent of which generally became effective January 1, 2009. Irs form 1040nr In this publication, the term “article” refers to the particular article of the treaty, as amended. Irs form 1040nr Prev  Up  Next   Home   More Online Publications
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The Irs Form 1040nr

Irs form 1040nr 18. Irs form 1040nr   Appendix This appendix contains models of the certificates, waivers, reports, and statements discussed in Part One. Irs form 1040nr Model Certificate A   STATEMENT OF SUBSEQUENT SELLER     1. Irs form 1040nr                 Name, address, and employer identification number of seller in subsequent sale             2. Irs form 1040nr                 Name, address, and employer identification number of the buyer in subsequent sale             3. Irs form 1040nr         Date and location of subsequent sale             4. Irs form 1040nr         Volume and type of taxable fuel sold               The undersigned seller (“Seller”) has received the copy of the first taxpayer's report provided with this statement in     connection with Seller's purchase of the taxable fuel described in this statement. Irs form 1040nr       Under penalties of perjury, Seller declares that Seller has examined this statement, including any accompanying     schedules and statements, and, to the best of Seller's knowledge and belief, they are true, correct and complete. Irs form 1040nr                   Signature and date signed                   Printed or typed name of person signing this report                   Title—   Model Certificate B   FIRST TAXPAYER'S REPORT   1. Irs form 1040nr                     First Taxpayer's name, address and employer identification number     2. Irs form 1040nr                     Name, address, and employer identification number of the buyer of the taxable fuel subject to tax     3. Irs form 1040nr           Date and location of removal, entry, or sale       4. Irs form 1040nr           Volume and type of taxable fuel removed, entered or sold     5. Irs form 1040nr Check type of taxable event:         Removal from refinery         Entry into United States         Bulk transfer from terminal by unregistered position holder       Bulk transfer not received at an approved terminal       Sale within the bulk transfer/terminal system       Removal at the terminal rack         Removal or sale by the blender                   6. Irs form 1040nr           Amount of federal excise tax paid on account of the removal, entry, or sale                   The undersigned taxpayer (“Taxpayer”) has not received, and will not claim, a credit with respect to, or a refund of, the tax     on the taxable fuel to which this form relates. Irs form 1040nr       Under penalties of perjury, Taxpayer declares that Taxpayer has examined this statement, including any accompanying     schedules and statements, and to the best of Taxpayer's knowledge and belief, they are true, correct and complete. Irs form 1040nr             Signature and date signed               Printed or typed name of person signing this report               Title     Model Certificate C   NOTIFICATION CERTIFICATE OF TAXABLE FUEL REGISTRANT                           Name, address, and employer identification number of person receiving certificate       The undersigned taxable registrant (“Registrant”) hereby certifies under penalties of perjury that Registrant is registered     by the Internal Revenue Service with registration number and that Registrant's registration has not     been revoked or suspended by the Internal Revenue Service. Irs form 1040nr                 Registrant understands that the fraudulent use of this certificate may subject Registrant and all parties making such     fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr                       Signature and date signed                         Printed or typed name of person signing                         Title of person signing                         Name of Registrant                         Employer identification number                         Address of Registrant     Model Certificate D   CERTIFICATE OF PERSON BUYING GASOLINE BLENDSTOCKS FOR USE OTHER THAN IN THE PRODUCTION OF FINISHED GASOLINE     (To support tax-free sales (other than LUST) under section 4081 of the Internal Revenue Code. Irs form 1040nr )                 Name, address, and employer identification number of seller       The undersigned buyer (“Buyer”) hereby certifies the following under penalties of perjury:       The gasoline blendstocks to which this certificate relates will not be used to produce finished gasoline. Irs form 1040nr       This certificate applies to the following (complete as applicable):       If this is a single purchase certificate, check here and enter:     1. Irs form 1040nr Invoice or delivery ticket number       2. Irs form 1040nr (number of gallons) of(type of gasoline blendstocks)       If this is a certificate covering all purchases under a specified account or order number, check here and enter:     1. Irs form 1040nr Effective date       2. Irs form 1040nr Expiration date       (period not to exceed 1 year after the effective date)       3. Irs form 1040nr Type (or types) of gasoline blendstocks     4. Irs form 1040nr Buyer's account or order number         Buyer will not claim a credit or refund under section 6427(h) of the Internal Revenue Code for any gasoline blendstocks     covered by this certificate. Irs form 1040nr         Buyer will provide a new certificate to the seller if any information in this certificate changes. Irs form 1040nr       If Buyer resells the gasoline blendstocks to which this certificate relates, Buyer will be liable for tax unless Buyer obtains a     certificate from the purchaser stating that the gasoline blendstocks will not be used to produce finished gasoline and otherwise complies with the conditions of §48. Irs form 1040nr 4081-4(b)(3) of the Manufacturers and Retailers Excise Tax Regulations. Irs form 1040nr       Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's     right to provide a certificate. Irs form 1040nr       Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. Irs form 1040nr     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 gasoline blendstocks tax free. Irs form 1040nr       Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use     of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr             Signature and date signed               Printed or typed name of person signing               Title of person signing               Name of Buyer               Employer identification number               Address of Buyer     Model Certificate G   CERTIFICATE OF REGISTERED FEEDSTOCK USER     (To support tax-free removals and entries (other than LUST) of kerosene under section 4082 of the Internal Revenue Code. Irs form 1040nr )         (Buyer) certifies the following under penalties of perjury:       Name of buyer         Buyer is a registered feedstock user with registration number . Irs form 1040nr Buyer's registration has not been revoked     or suspended. Irs form 1040nr         The kerosene to which this certificate applies will be used by Buyer for a feedstock purpose. Irs form 1040nr                 This certificate applies to percent of Buyer's purchases from (name, address, and employer     identification number of seller) as follows (complete as applicable):       1. Irs form 1040nr A single purchase on invoice or delivery ticket number . Irs form 1040nr                 2. Irs form 1040nr All purchases between (effective date) and (expiration date) (period not to exceed     one year after the effective date) under account or order number(s) . Irs form 1040nr If this certificate applies only to Buyer's     purchases for certain locations, check here and list the locations. Irs form 1040nr                                   If Buyer sells the kerosene to which this certificate relates, Buyer will be liable for tax on that sale. Irs form 1040nr                 Buyer will provide a new certificate to the seller if any information in this certificate changes. Irs form 1040nr                 If Buyer violates the terms of this certificate, the Internal Revenue Service may revoke the Buyer's registration. Irs form 1040nr                 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. Irs form 1040nr             Printed or typed name of person signing               Title of person signing               Employer identification number               Address of Buyer               Signature and date signed     Model Certificate J   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. Irs form 1040nr )                                         Name, address, and employer identification number of seller                   (“Buyer”) certifies the following under penalties of perjury:     Name of buyer                     The CNG to which this certificate relates will be used in a nontaxable use. Irs form 1040nr       This certificate applies to the following (complete as applicable):               If this is a single purchase certificate, check here and enter:       1. Irs form 1040nr Invoice or delivery ticket number       2. Irs form 1040nr (Gasoline gallon equivalents)       If this is a certificate covering all purchases under a specified account or order number, check here and enter:         1. Irs form 1040nr Effective date         2. Irs form 1040nr Expiration date         (period not to exceed 1 year after the effective date)         3. Irs form 1040nr Buyer's 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. Irs form 1040nr       Buyer will provide a new certificate to the seller if any information in this certificate changes. Irs form 1040nr       Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's     right to provide a certificate. Irs form 1040nr       Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. Irs form 1040nr     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. Irs form 1040nr       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. Irs form 1040nr             Printed or typed name of person signing               Title of person signing             Employer identification number               Address of Buyer               Signature and date signed     Model Certificate K   CERTIFICATE OF PERSON BUYING KEROSENE FOR USE IN AVIATION FOR     COMMERCIAL AVIATION OR NONTAXABLE USE     (To support operator liability for tax on removals of kerosene for use in aviation directly into the fuel tank of an aircraft in commercial aviation pursuant to § 4081 of the Internal Revenue Code or to support a tax rate of zero under § 4041(c) pursuant to §§4041(c) and 4082. Irs form 1040nr )           Name, address, and employer identification number of position holder       The undersigned aircraft operator (“Buyer”) hereby certifies the following under the penalties of perjury:       The kerosene for use in aviation to which this certificate relates is purchased (check one): for     use on a farm for farming purposes; for use in foreign trade (reciprocal benefits required for foreign registered airlines); for use in certain helicopter and fixed-wing air ambulance uses; for use other than as a fuel in the propulsion engine of an aircraft; for the exclusive use of a qualified blood collector organization; for the exclusive use of a nonprofit educational organization; for the exclusive use of a state; for use in an aircraft owned by an aircraft museum; for use in military aircraft; or for use in commercial aviation (other than foreign trade). Irs form 1040nr       With respect to kerosene for use in aviation purchased after June 30, 2005, for use in commercial aviation     (other than foreign trade), Buyer's registration number is. Irs form 1040nr Buyer's registration has not been suspended or revoked by the Internal Revenue Service. Irs form 1040nr       This certificate applies to the following (complete as applicable):     This is a single purchase certificate:       1. Irs form 1040nr Invoice or delivery ticket number       2. Irs form 1040nr Number of gallons     This is a certificate covering all purchases under a specified account or order number:       1. Irs form 1040nr Effective date       2. Irs form 1040nr Expiration date (period not to exceed 1 year after the effective date)       3. Irs form 1040nr Buyer's account number       Buyer agrees to provide the person liable for tax with a new certificate if any information in this certificate changes. Irs form 1040nr       If the kerosene for use in aviation to which this certificate relates is being bought for use in commercial aviation     (other than foreign trade), Buyer is liable for tax on its use of the fuel and will pay that tax to the government. Irs form 1040nr       If Buyer sells or uses the kerosene for use in aviation to which this certificate relates for a use other than the use     stated above, Buyer will be liable for tax. Irs form 1040nr       Buyer understands that it must be prepared to establish by satisfactory evidence the purpose for which the     fuel purchased under this certificate was used. Irs form 1040nr     Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. Irs form 1040nr     If Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's right to provide a certificate. Irs form 1040nr       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. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Waiver L WAIVER FOR USE BY ULTIMATE PURCHASERS OF KEROSENE FOR CERTAIN USES IN AVIATION (To support vendor's claim for a credit or payment under § 6427(l)(4)(C)(i) of the Internal Revenue Code. Irs form 1040nr )               Name, Address, and Employer Identification Number of Ultimate Vendor     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. Irs form 1040nr The kerosene to which this waiver relates is purchased for — (check one):       1. Irs form 1040nr □ Use on a farm for farming purposes,       2. Irs form 1040nr □ Use in foreign trade (reciprocal benefits required for foreign registered airlines),       3. Irs form 1040nr □ Use in certain helicopter and fixed-wing air ambulance uses,       4. Irs form 1040nr □ The exclusive use of a qualified blood collector organization,       5. Irs form 1040nr □ The exclusive use of a nonprofit educational organization,       6. Irs form 1040nr □ Use in an aircraft owned by an aircraft museum,       7. Irs form 1040nr □ Use in military aircraft, or       8. Irs form 1040nr □ Use in commercial aviation (other than foreign trade). Irs form 1040nr     B. Irs form 1040nr This waiver applies to the following (complete as applicable):       This is a single purchase waiver:           1. Irs form 1040nr Invoice or delivery ticket number           2. Irs form 1040nr Number of gallons       This is a waiver covering all purchases under a specified account or order number:           1. Irs form 1040nr Effective date           2. Irs form 1040nr Expiration date (period not to exceed 1 year after the effective date)           3. Irs form 1040nr Buyer's account number       Buyer will provide a new waiver to the vendor if any information in this waiver changes. Irs form 1040nr       If Buyer uses the kerosene for use in aviation to which this waiver relates for a use other than the use stated above, Buyer will be liable for tax. Irs form 1040nr       Buyer understands that by signing this waiver, Buyer gives up its right to claim any credit or payment for the kerosene for use in aviation used in a nontaxable use. Irs form 1040nr       Buyer acknowledges that it has not and will not claim any credit or payment for the kerosene for use in aviation to which this waiver relates. Irs form 1040nr       Buyer understands that the fraudulent use of this waiver may subject Buyer and all parties making such fraudulent use of this waiver to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate M   CERTIFICATE FOR STATE USE OR NONPROFIT EDUCATIONAL     ORGANIZATION USE     (To support vendor's claim for a credit or payment under § 6416(a)(4) of the Internal Revenue Code. Irs form 1040nr )                       Name, address, and employer identification number of ultimate vendor       The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under the penalties of perjury:       Buyer will use the gasoline or aviation gasoline to which this certificate relates (check one):     For the exclusive use of a state or local government; or     For the exclusive use of a nonprofit educational organization. Irs form 1040nr       This certificate applies to the following (complete as applicable):     This is a single purchase certificate:       1. Irs form 1040nr Invoice or delivery ticket number       2. Irs form 1040nr Number of gallons     This is a certificate covering all purchases under a specified account or order number:       1. Irs form 1040nr Effective date       2. Irs form 1040nr Expiration date (period not to exceed 1 year after the effective date)       3. Irs form 1040nr Buyer's account number       Buyer will provide a new certificate to the vendor if any information in this certificate changes. Irs form 1040nr       Buyer understands that by signing this certificate, Buyer gives up its right to claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. Irs form 1040nr       Buyer acknowledges that it has not and will not claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. Irs form 1040nr       Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Waiver N   WAIVER FOR USE BY ULTIMATE PURCHASERS OF DIESEL FUEL OR     KEROSENE USED IN INTERCITY BUS TRANSPORTATION     (To support vendor's claim for a credit or payment under § 6427 of the Internal Revenue Code. Irs form 1040nr )                       Name, address, and employer identification number of ultimate vendor       The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under the penalties of perjury:       The diesel fuel or kerosene to which this waiver relates is purchased for use in intercity bus transportation. Irs form 1040nr       This waiver applies to the following (complete as applicable):     This is a single purchase waiver:       1. Irs form 1040nr Invoice or delivery ticket number       2. Irs form 1040nr Number of gallons     This is a waiver covering all purchases under a specified account or order number:       1. Irs form 1040nr Effective date       2. Irs form 1040nr Expiration date (period not to exceed 1 year after the effective date)       3. Irs form 1040nr Buyer's account number       Buyer will provide a new waiver to the vendor if any information in this waiver changes. Irs form 1040nr       If Buyer uses the diesel fuel or kerosene to which this waiver relates for a use other than in intercity bus transportation, Buyer will be liable for tax. Irs form 1040nr       Buyer understands that by signing this waiver, Buyer gives up its right to claim any credit or payment for the diesel fuel or kerosene used in intercity bus transportation. Irs form 1040nr       Buyer acknowledges that it has not and will not claim any credit or payment for the diesel fuel or kerosene to which this waiver relates. Irs form 1040nr       Buyer understands that the fraudulent use of this waiver may subject Buyer and all parties making such fraudulent use of this waiver to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate O   CERTIFICATE FOR BIODIESEL     Certificate Identification Number:     (To support a claim related to biodiesel or a biodiesel mixture under section 6426 of the Internal Revenue Code. Irs form 1040nr )     The undersigned biodiesel producer (“Producer”) hereby certifies the following under penalties of perjury:   1. Irs form 1040nr             Producer's name, address, and employer identification number (EIN)   2. Irs form 1040nr             Name, address, and EIN of person buying the biodiesel from Producer   3. Irs form 1040nr       Date and location of sale to buyer   4. Irs form 1040nr This certificate applies to gallons of biodiesel. Irs form 1040nr   5. Irs form 1040nr Producer certifies that the biodiesel to which this certificate relates is:       % Agri-biodiesel (derived solely from virgin oils)       % Biodiesel other than agri-biodiesel       This certificate applies to the following sale:       Invoice or delivery ticket number       Total number of gallons of biodiesel sold under that invoice or delivery ticket number (including biodiesel not covered by this certificate)       Total number of certificates issued for that invoice or delivery ticket number   6. Irs form 1040nr             Name, address, and employer identification number of reseller to whom certificate is issued (only in the case of certificates reissued to a reseller after the return of the original certificate)   7. Irs form 1040nr Original Certificate Identification Number (only in the case of certificates reissued to a reseller after return of the original certificate). Irs form 1040nr       Producer is registered as a biodiesel producer with registration number . Irs form 1040nr  Producer's registration has not been suspended or revoked by the Internal Revenue Service. Irs form 1040nr       Producer certifies that the biodiesel to which this certificate relates in monoalkyl esters of long chain fatty acids derived from plant or animal matter that meets the requirements of the American Society of Testing and Materials D6751 and the registration requirements for fuels and fuel additives established by EPA under section 211 of the Clean Air Act (42 U. Irs form 1040nr S. Irs form 1040nr C. Irs form 1040nr 7545). Irs form 1040nr       Producer understands that the fraudulent use of this certificate may subject Producer and all parties making any fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing this certificate           Title of person signing           Signature and date signed   Model Certificate P CERTIFICATE OF STATE USE (To support vendor's claim for credit or payment under section 6427 of the Internal Revenue Code. Irs form 1040nr )               Name, Address, and Employer Identification Number of Vendor     The undersigned buyer (“Buyer”) hereby certifies the following under penalties of perjury:     A. Irs form 1040nr Buyer will use the diesel fuel or kerosene to which this certificate relates for the exclusive use of a state or local government, or the District of Columbia. Irs form 1040nr     B. Irs form 1040nr This certificate applies to the following (complete as applicable):       1. Irs form 1040nr   If this is a single purchase certificate, check here □ and enter:           a. Irs form 1040nr Invoice or delivery ticket number           b. Irs form 1040nr Number of gallons       2. Irs form 1040nr   If this is a certificate covering all purchases under a specified account or order number, check here □  and enter:           a. Irs form 1040nr Effective date           b. Irs form 1040nr Expiration date   (period not to exceed 1 year after effective date)           c. Irs form 1040nr Buyer's account or order number     ▪ Buyer will provide a new certificate to the vendor if any information in this certificate changes. Irs form 1040nr     ▪ If Buyer uses the diesel fuel or kerosene to which this certificate relates for a purpose other than stated in the certificate, Buyer will be liable for any tax. Irs form 1040nr     ▪ Buyer acknowledges that it has not and will not claim any credit or payment for the diesel fuel or kerosene to which this certificate relates. Irs form 1040nr     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate Q CERTIFICATE OF ULTIMATE PURCHASER OF KEROSENE FOR USE IN NONEXEMPT, NONCOMMERCIAL AVIATION (To support vendor's claim for credit or payment under section 6427(l)(4)(C)(ii) of the Internal Revenue Code. Irs form 1040nr )               Name, Address, and Employer Identification Number of Ultimate Vendor     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. Irs form 1040nr The kerosene to which this certificate relates is purchased for a nonexempt use in noncommercial aviation. Irs form 1040nr     B. Irs form 1040nr This certificate applies to the following (complete as applicable):       1. Irs form 1040nr   If this is a single purchase certificate, check here □ and enter:           a. Irs form 1040nr Invoice or delivery ticket number           b. Irs form 1040nr Number of gallons       2. Irs form 1040nr   This is a certificate covering all purchases under a specified account or order number:           a. Irs form 1040nr Effective date           b. Irs form 1040nr Expiration date   (period not to exceed 1 year after effective date)           c. Irs form 1040nr Buyer's account number     ▪ Buyer will provide a new certificate to the vendor if any information in this certificate changes. Irs form 1040nr     ▪ If Buyer uses the kerosene to which this certificate relates for a use other than the nontaxable use stated above, Buyer will be liable for tax. Irs form 1040nr     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate R CERTIFICATE OF BUYER OF TAXABLE FUEL FOR USE BY A STATE OR NONPROFIT EDUCATIONAL ORGANIZATION (To support credit card issuer's claim for credit, refund, or payment under section 6416(a)(4)(B) or section 6427(l)(5)(D) of the Internal Revenue Code. Irs form 1040nr )               Name, Address, and Employer Identification Number of Credit Card Issuer. Irs form 1040nr     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. Irs form 1040nr Buyer will use the taxable fuel to which this certificate relates for the exclusive use of a state; or     B. Irs form 1040nr Buyer will use the gasoline to which this certificate relates for the exclusive use of a nonprofit educational organization. Irs form 1040nr     C. Irs form 1040nr This certificate applies to all purchases made with the credit card identified below during the period specified:           a. Irs form 1040nr Effective date of certificate           b. Irs form 1040nr Expiration date of certificate   (period not to exceed 2 years after effective date)           c. Irs form 1040nr Buyer's account number     ▪ Buyer will provide a new certificate to the credit card issuer if any information in this certificate changes. Irs form 1040nr     ▪ Buyer understands that by signing this certificate, Buyer gives up its right to claim a credit or payment for the taxable fuel purchased with the credit card to which this certificate relates. Irs form 1040nr     ▪ Buyer acknowledges that it has not and will not claim any credit or payment for the taxable fuel purchased with the credit card to which this certificate relates. Irs form 1040nr     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Statement S   STATEMENT OF BIODIESEL RESELLER     (To support a claim related to biodiesel or a biodiesel mixture under section 6426 of the Internal Revenue Code. Irs form 1040nr )     The undersigned biodiesel producer (“Reseller”) hereby certifies the following under penalties of perjury:   1. Irs form 1040nr                   Reseller's name, address, and employer identification number (EIN)   2. Irs form 1040nr                   Name, address, and EIN of Reseller's buyer   3. Irs form 1040nr       Date and location of sale to buyer   4. Irs form 1040nr Volume of biodiesel sold   5. Irs form 1040nr Certificate Identification Number on the Certificate for Biodiesel       Reseller has bought the biodiesel described in the accompanying Certificate for Biodiesel and Reseller has no reason to believe that any information in the certificate is false. Irs form 1040nr       Reseller has not been notified by the Internal Revenue Service that its right to provide a certificate or statement has been withdrawn. Irs form 1040nr       Reseller understands that the fraudulent use of this statement may subject Reseller and all parties making any fraudulent use of this statement to a fine or imprisonment, or both, together with the costs of prosecution. Irs form 1040nr           Printed or typed name of person signing this certificate           Title of person signing           Signature and date signed   Prev  Up  Next   Home   More Online Publications