Form PPT-5 "Petroleum Products Gross Receipts Tax Exempt Use Certificate" - New Jersey

What Is Form PPT-5?

This is a legal form that was released by the New Jersey Department of the Treasury - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2013;
  • The latest edition provided by the New Jersey Department of the Treasury;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form PPT-5 by clicking the link below or browse more documents and templates provided by the New Jersey Department of the Treasury.

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Download Form PPT-5 "Petroleum Products Gross Receipts Tax Exempt Use Certificate" - New Jersey

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06-2013
Pursuant to NJSA 54:15B-1 et seq
Petroleum Products Gross Receipts Tax
Form PPT-5
Exempt Use Certificate
Check box if using this form as a BLANKET FORM
Date of Purchase — leave blank if using BLANKET FORM
By checking, issuer affirms that this form covers all transactions between the
dates shown. Under Gallons Received or Consideration Given, enter “ALL”
From:
To:
BOL Number — leave blank if using BLANKET FORM
Gallons Received or
Product Received
Consideration Given
Seller’s Name
Gasoline
Denatured Ethanol
Seller’s Permit Number
Blended Ethanol
Selling Company’s Contact Person
Aviation Gasoline
:
Diesel
Phone
Ext
Dyed Diesel or #2 Heating Fuel Oil
Email
BioDiesel
Purchaser’s Name
Dyed BioDiesel
Jet Fuel
Purchaser’s FIEN
Kerosene
Purchasing Company’s Contact Person
Dyed Kerosene
#4 Fuel Oil
Phone
Ext:
#5 Fuel Oil
Email
#6 Fuel Oil
Propane
$
Butane
$
Lubricants (specify)
$
Solvents (specify)
$
Other (specifiy)
$
The Purchaser is claiming the following Exempt Use:
Heating food, air, or water in a residence
Commercial Fishing
Use in Marine Vessels engaged in Interstate or International Commerce
Use for a qualified non-profit organization under a contract with the Seller that is one year or longer in duration — the purchaser must
attach its ST-5 to this form in order to claim this exemption
Use by the State of New Jersey or any of its political subdivisions, or any agency thereof, or use by the United States Government or its
agencies or instrumentalities.
Other (Specify Exemption)
Affirmation
The Signatory certifies that the above product(s)
/
purchased by the Purchaser identified above for the sole use of said purchaser. The purchaser used the product(s) in
was
were
the exempt manner specified. Any other use, or any incomplete or untrue information will produce a tax liability for which the purchaser alone is responsible. The purchaser
will make records related to transactions in petroleum products et al available upon request.
Signature
Signatory Printed Name
Signatory Title
Date Signed
06-2013
Pursuant to NJSA 54:15B-1 et seq
Petroleum Products Gross Receipts Tax
Form PPT-5
Exempt Use Certificate
Check box if using this form as a BLANKET FORM
Date of Purchase — leave blank if using BLANKET FORM
By checking, issuer affirms that this form covers all transactions between the
dates shown. Under Gallons Received or Consideration Given, enter “ALL”
From:
To:
BOL Number — leave blank if using BLANKET FORM
Gallons Received or
Product Received
Consideration Given
Seller’s Name
Gasoline
Denatured Ethanol
Seller’s Permit Number
Blended Ethanol
Selling Company’s Contact Person
Aviation Gasoline
:
Diesel
Phone
Ext
Dyed Diesel or #2 Heating Fuel Oil
Email
BioDiesel
Purchaser’s Name
Dyed BioDiesel
Jet Fuel
Purchaser’s FIEN
Kerosene
Purchasing Company’s Contact Person
Dyed Kerosene
#4 Fuel Oil
Phone
Ext:
#5 Fuel Oil
Email
#6 Fuel Oil
Propane
$
Butane
$
Lubricants (specify)
$
Solvents (specify)
$
Other (specifiy)
$
The Purchaser is claiming the following Exempt Use:
Heating food, air, or water in a residence
Commercial Fishing
Use in Marine Vessels engaged in Interstate or International Commerce
Use for a qualified non-profit organization under a contract with the Seller that is one year or longer in duration — the purchaser must
attach its ST-5 to this form in order to claim this exemption
Use by the State of New Jersey or any of its political subdivisions, or any agency thereof, or use by the United States Government or its
agencies or instrumentalities.
Other (Specify Exemption)
Affirmation
The Signatory certifies that the above product(s)
/
purchased by the Purchaser identified above for the sole use of said purchaser. The purchaser used the product(s) in
was
were
the exempt manner specified. Any other use, or any incomplete or untrue information will produce a tax liability for which the purchaser alone is responsible. The purchaser
will make records related to transactions in petroleum products et al available upon request.
Signature
Signatory Printed Name
Signatory Title
Date Signed