Attachment 2a Kerosene Waiver.pdf
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- Solicitation number
- HTC711-23-R-CC01
About this file
This document contains a waiver for use by ultimate purchasers of kerosene for certain uses in aviation. The waiver allows purchasers to claim a credit or payment for kerosene used for approved purposes including use on a farm for farming purposes, in foreign trade under reciprocal benefits for foreign registered airlines, in certain helicopter and fixed-wing air ambulance uses, for the exclusive use of a qualified blood collector organization or nonprofit educational organization, or in aircraft owned by an aircraft museum or used in military aircraft.
The waiver requires the purchaser to specify whether it is for a single purchase or multiple purchases under an account or order number. For a single purchase, the invoice or delivery ticket number and number of gallons must be provided. For multiple purchases, the effective date and expiration date within one year must be listed along with the purchaser's account number. The purchaser acknowledges that they have not and will not claim any credit or payment for kerosene covered under the waiver and understands fraudulent use may result in fines or imprisonment.
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Text version
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.)
Name, Address, and Employer Identification Number of Ultimate Vendor
The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:
A. The kerosene to which this waiver relates is purchased for — (check one):
_ Use on a farm for farming purposes, _ Use in foreign trade (reciprocal benefits required for foreign registered airlines), _ Use in certain helicopter and fixed-wing air ambulance uses, _ The exclusive use of a qualified blood collector organization, _ The exclusive use of a nonprofit educational organization, _ Use in an aircraft owned by an aircraft museum, _ Use in military aircraft.
B. This waiver applies to the following (complete as applicable):
__________This is a single purchase waiver:
1. ______________ Invoice or delivery ticket number
2. ______________ Number of gallons
__________This is a waiver 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’s account number.
Buyer will provide a new waiver to the vendor if any information in this waiver changes. 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.
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. 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. 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.
Printed or typed name of person signing Title of person signing Name of Buyer Employer identification number Address of Buyer Signature and date signed
DESC March 2008
| DEFENSE LOGISTICS AGENCY (DLA) |
| DLA ENERGY |
| 8725 John J. Kingman Rd., Suite 4950 |
| Fort Belvoir, Virginia 22060-6222 |
| FUEL PURCHASE AGREEMENT (FPA) |
| At Department of Defense location(s): (attach list if necessary) |
| Department/Agency: _______________________________________ |
| Contract Number(s): _______________________________________ |
| Department/Agency: ________________________________________ |
| Contract Number: __________________________________________ |
| Chief, Retail Management Division |
| DLA Energy |
| Text1: HTC711-18-R-CC01 |
| Text2: Attachment 2a |
File details come from the government source that posted it. Updated .