Form DS-99 APPLICATION FOR DIPLOMATIC EXEMPTION FROM TAXES ON GASOL

U.S. Department of State
(PLEASE TYPE)

PID Number

Type of
Account

Name - Office* OR Individual

OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 5 minutes*

APPLICATION FOR DIPLOMATIC EXEMPTION FROM
TAXES ON GASOLINE
Location (City)

Country

Personal
Mission

(Last, First and MI.) * For Offices, please also include a contact person.

Vehicle Tag Numbers
#1

#2

Date of Birth (mm-dd-yyyy)

#3

#4
Oil Company Account Number

Oil Company

FOR OFFICE USE ONLY
Embassy
DS-99
xx-xxxx

Consulate

UN

(Formerly DSP-99A)

OAS

R

Other

Page 1 of 2

This Application Is Not Valid for Sales Tax Exemption
U.S. Department of State

(PLEASE TYPE)

PID Number

Type of
Account

Name - Office* OR Individual

OMB Approval No. 1405-0105
Expires: xx-xx-xxxx
Estimated burden: 5 minutes*

APPLICATION FOR DIPLOMATIC EXEMPTION FROM
TAXES ON GASOLINE
Country

Personal

Location (City)

Mission
(Last, First and MI.) * For Offices, please also include a contact person.

Vehicle Tag Numbers
#1

#2

Date of Birth (mm-dd-yyyy)

#3

Oil Company

#4
Oil Company Account Number

FOR OFFICE USE ONLY
Embassy
DS-99
xx-xxxx

Consulate

UN

OAS

R

Other

(Formerly DSP-99A)

Page 1 of 2

This Application Is Not Valid for Sales Tax Exemption

U.S. Department of State
(PLEASE TYPE)

PID Number

Type of
Account

Name - Office* OR Individual

OMB Approval No. 1405-0105
Expires:xx-xx-xxxx
Estimated burden: 5 minutes*

APPLICATION FOR DIPLOMATIC EXEMPTION FROM
TAXES ON GASOLINE
Location (City)

Country

Personal
Mission

(Last, First and MI.) * For Offices, please also include a contact person.

Vehicle Tag Numbers
#1

#2

#3

Oil Company

Date of Birth (mm-dd-yyyy)

#4
Oil Company Account Number

FOR OFFICE USE ONLY
Embassy
DS-99
xx-xxxx

(Formerly DSP-99A)

Consulate

UN

OAS

Other

This Application Is Not Valid for Sales Tax Exemption

R
Page 1 of 2

Privacy Act Statement
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular
Relations of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions
Act of 1982 (22 U.S.C. 4301-4316) as amended.
PURPOSE: The information solicited on this form will be used to adjudicate requests for diplomatic exemption from taxes on gasoline.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
statutorily authorized purposes as covered under STATE 36, Security Records. This information also may be provided to the employing foreign
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of diplomatic
exemption from taxes on gasoline.
Paperwork Reduction Act Statement
*Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final
collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments
on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW,
Washington, DC 20008.
DS-99

Page 2 of 2

Privacy Act Statement
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular
Relations of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions
Act of 1982 (22 U.S.C. 4301-4316) as amended.
PURPOSE: The information solicited on this form will be used to adjudicate requests for diplomatic exemption from taxes on gasoline.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
statutorily authorized purposes as covered under STATE 36, Security Records. This information also may be provided to the employing foreign
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of diplomatic
exemption from taxes on gasoline.
Paperwork Reduction Act Statement
*Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final
collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments
on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW,
Washington, DC 20008.
DS-99

Page 2 of 2

Privacy Act Statement
AUTHORITIES: The information is sought pursuant to Vienna Convention on Diplomatic Relations of 1961; Vienna Convention on Consular
Relations of 1963; Diplomatic Relations Act (22 U.S.C. 254a-e); International Organizations Immunities Act (22 U.S.C. 288e (a)); Foreign Missions
Act of 1982 (22 U.S.C. 4301-4316) as amended.
PURPOSE: The information solicited on this form will be used to adjudicate requests for diplomatic exemption from taxes on gasoline.
ROUTINE USES: The information provided on this form may be provided to other federal agencies for law enforcement, administrative or other
statutorily authorized purposes as covered under STATE 36, Security Records. This information also may be provided to the employing foreign
government or international organization.
DISCLOSURE: Providing this information is voluntary; Failure to provide the information requested on this form may result in denial of diplomatic
exemption from taxes on gasoline.
Paperwork Reduction Act Statement
*Public reporting burden for this collection of information is estimated to average 5 minutes per response, including time required for searching
existing data sources, gathering the necessary documentation, providing the information and/or documents required, and reviewing the final
collection. You do not have to supply this information unless this collection displays a currently valid OMB control number. If you have comments
on the accuracy of this burden estimate and/or recommendations for reducing it, please send them to: M/OFM, 3507 International Place NW,
Washington, DC 20008.
DS-99

Page 2 of 2