Model Certificate of Person Buying Aviation-Grade Kerosene for Commercial Aviation or Nontaxable Use (Notice 2005-4)

OMB No. 1545-1915

Model
(ii)Certification
The date

the buyer provides the
seller a new certificate or notice that the
current certificate is invalid.

(iii) The date the Service or the buyer
notifies the seller that the buyer’s right to
provide a certificate has been withdrawn.

(2) Model certificate.

CERTIFICATE OF PERSON BUYING AVIATION-GRADE KEROSENE FOR
COMMERCIAL AVIATION OR NONTAXABLE USE
(To support operator liability for tax on removals of aviation-grade kerosene 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 pursuant to §§ 4041 and 4082.)

Name, address, and employer identification number of the position holder
The undersigned aircraft operator (“Buyer”) hereby certifies the following under the penalties of perjury:
The aviation-grade kerosene to which this certificate relates is purchased (check one):
for use on a farm for
farming purposes;
for export;
for use in foreign trade (reciprocal benefits required for foreign registered
airlines);
for use in certain helicopter and fixed-wing air ambulance uses;
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).
With respect to aviation-grade kerosene purchased after June 30, 2005, for use in commercial aviation (other than
foreign trade), Buyer’s registration number is
. Buyer’s registration has not been suspended or revoked
by the Internal Revenue Service.
This certificate applies to the following (complete as applicable):
This is a single purchase certificate:
1.

Invoice or delivery ticket number

2.

Number of gallons

This is a certificate covering all purchases under a specified account or order number:
1. Effective date
2. Expiration date

(period not to exceed 1 year after the effective date)

3. Buyer account number
Buyer agrees to provide the person liable for tax with a new certificate if any information in this certificate changes.
If the aviation-grade kerosene 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.
If Buyer sells or uses the aviation-grade kerosene to which this certificate relates for a use other than the use stated
above, Buyer will be liable for tax.
Buyer understands that it must be prepared to establish by satisfactory evidence the purpose for which the fuel purchased
under this certificate was used.
Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. If
Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer’s right to provide a certificate.
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

2005–2 I.R.B.

294

January 10, 2005

Name of Buyer
Employer identification number
Address of Buyer
Signature and date signed
(h) Claims by registered ultimate vendors (nontaxable uses)—(1) In general.
Section 6427(l)(4)(B) provides that if
an ultimate purchaser of aviation-grade
kerosene used for a nontaxable use waives
its right to an income tax credit or payment, in the form and manner prescribed
by the Secretary, and assigns such right
to the registered ultimate vendor, then the
ultimate vendor, and not the ultimate purchaser, may claim a payment or income
tax credit. Neither the Code nor this notice
requires any vendor to apply for registration or to file any claim.
(2) Definitions.
Nontaxable use means any use that is
exempt from the tax imposed by § 4041(c)
(other than by reason of a prior imposition
of tax) and any use in commercial aviation
within the meaning of § 4083(b).
Registered ultimate vendor is a person
that sells aviation-grade kerosene to the ultimate purchaser for a nontaxable use and
is registered as an ultimate vendor under
§ 4101.
(3) Conditions to allowance of credit
or payment. A claim for an income tax
credit or payment with respect to aviationgrade kerosene is allowable to an ultimate
vendor by § 6427(l)(4)(B) only if—
(i) Tax was imposed on the aviationgrade kerosene under § 4081;

(ii) The claimant sold the aviation-grade kerosene to the ultimate purchaser for use in a nontaxable use;
(iii) The claimant is a registered ultimate vendor;
(iv) The ultimate purchaser has waived
its right to a credit or payment as provided
in paragraph (h)(6) of this section; and
(v) The claimant has filed a timely
claim for a credit or payment and the
claim contains all of the information required in paragraph (h)(5) of this section.
(4) Form of claim. A claim under
§ 6427(l)(4)(B) for a payment is made on
Form 8849, Claim for Refund of Excise
Taxes, and a claim under § 6427(l)(4)(B)
for an income tax credit is made on Form
4136, Credit for Federal Tax Paid on Fuels.
(5) Content of claim. Each claim for a
credit or payment under § 6427(l)(4)(B)
must contain the following information
with respect to the aviation-grade kerosene
covered by the claim:
(i) The total number of gallons.
(ii) The claimant’s registration number.
(iii) A statement that the claimant—
(A) Has not included the amount of the
tax in its sales price of the aviation-grade
kerosene and has not collected the amount
of tax from its buyer;

(B) Has repaid the amount of the tax to
the ultimate purchaser of the fuel; or
(C) Has obtained the written consent of
its buyer to allowance of the claim.
(iv) A statement that the claimant has
in its possession an unexpired waiver described in paragraph (h)(6) of this section
and has no reason to believe any information in the waiver is false.
(6) Waiver—(i) In general. The ultimate purchaser waives its right to a credit
or payment for purposes of § 6427(l)(4)(B)
by providing a statement that is signed under penalties of perjury by a person with
authority to bind the ultimate purchaser, is
in substantially the same form as the model
waiver in paragraph (h)(6)(ii) of this section, and contains all of the information
necessary to complete such model waiver.
A new waiver must be given if any information in the current waiver changes.
The claimant must have the waiver at the
time the credit or payment is claimed under § 6427(l)(4)(B). The waiver may be
included as part of any business records
normally used to document a sale. The
waiver expires on the earlier of the following dates:
(A) The date one year after the effective
date of the waiver, or
(B) The date a new waiver is provided.
(ii) Model waiver.

WAIVER FOR USE BY ULTIMATE PURCHASERS OF
AVIATION-GRADE KEROSENE USED IN NONTAXABLE USES
(To support vendor’s claim for a credit or payment under § 6427 of the Internal Revenue Code.)

Name, address, and employer identification number of ultimate vendor
The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under the penalties of perjury:

January 10, 2005

295

2005–2 I.R.B.