Form AVF-105 (State Form 55314) "Aviation Fuel Excise Tax Exemption Certificate" - Indiana

This "Form Avf-105 State Form 55314 "aviation Fuel Excise Tax Exemption Certificate" - Indiana" is a part of the paperwork released by the Indiana Department of Revenue specifically for Indiana residents.

The latest fillable version of the document was released on July 1, 2013 and can be downloaded through the link below or found through the department's forms library.

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Download Form AVF-105 (State Form 55314) "Aviation Fuel Excise Tax Exemption Certificate" - Indiana

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Indiana Department of Revenue
AVF-105
State Form 55314
Aviation Fuel Excise Tax Exemption Certifi cate
(R / 7-13)
Name of Purchaser _______________________________________________________________________________
Business Address _______________________ City ______________________ State ________ Zip ______________
Provide your Indiana Registered Retail Merchant
Certifi cate, TID, and LOC number, as shown on
your certifi cate ..................................................................
_________________________
____________
TID Number (10 digits)
LOC Number (3 digits)
If not registered with the Indiana Department of
Revenue, provide your state tax ID number
from another state ............................................................
_________________________
_________________
State ID Number
State of Issue
If you do not have either an Indiana TID number or another state ID number, you must provide one of the following:
Public transportation haulers operating under another carrier’s authority must enter their Social Security number or federal
identifi cation number on the State ID Number line.
Is this a
blanket purchase exemption or a
single purchase exemption? (check one)
Purchaser must indicate the type of exemption being claimed for this purchase. (check one):
United States federal government - show agency name _______________________________________________
Note: A U.S. government agency should enter its federal identification number (FID) in lieu of a state ID number.
The state of Indiana
The Indiana Air National Guard
Common carrier of passengers or freight
Sales for resale only
I hereby certify under the penalties of perjury that the aviation fuel purchased with this exemption certifi cate is to be placed
into the fuel supply tank of an aircraft.
I confi rm my understanding that the misuse (either negligent or intentional) and/or fraudulent use of this certifi cate may
subject both me personally and/or the business entity I represent to the imposition of tax, interest, and civil and/or criminal
penalties.
Printed Name ____________________________________________
Title ________________________________
Signature of Purchaser ____________________________________
Date ________________________________
Email ________________________________________
Telephone Number _______________________________
The Indiana Department of Revenue may request verifi cation of registration in another state if you are an out-of-state
purchaser.
Seller must keep this certifi cate on fi le to support exempt sales.
Indiana Department of Revenue
AVF-105
State Form 55314
Aviation Fuel Excise Tax Exemption Certifi cate
(R / 7-13)
Name of Purchaser _______________________________________________________________________________
Business Address _______________________ City ______________________ State ________ Zip ______________
Provide your Indiana Registered Retail Merchant
Certifi cate, TID, and LOC number, as shown on
your certifi cate ..................................................................
_________________________
____________
TID Number (10 digits)
LOC Number (3 digits)
If not registered with the Indiana Department of
Revenue, provide your state tax ID number
from another state ............................................................
_________________________
_________________
State ID Number
State of Issue
If you do not have either an Indiana TID number or another state ID number, you must provide one of the following:
Public transportation haulers operating under another carrier’s authority must enter their Social Security number or federal
identifi cation number on the State ID Number line.
Is this a
blanket purchase exemption or a
single purchase exemption? (check one)
Purchaser must indicate the type of exemption being claimed for this purchase. (check one):
United States federal government - show agency name _______________________________________________
Note: A U.S. government agency should enter its federal identification number (FID) in lieu of a state ID number.
The state of Indiana
The Indiana Air National Guard
Common carrier of passengers or freight
Sales for resale only
I hereby certify under the penalties of perjury that the aviation fuel purchased with this exemption certifi cate is to be placed
into the fuel supply tank of an aircraft.
I confi rm my understanding that the misuse (either negligent or intentional) and/or fraudulent use of this certifi cate may
subject both me personally and/or the business entity I represent to the imposition of tax, interest, and civil and/or criminal
penalties.
Printed Name ____________________________________________
Title ________________________________
Signature of Purchaser ____________________________________
Date ________________________________
Email ________________________________________
Telephone Number _______________________________
The Indiana Department of Revenue may request verifi cation of registration in another state if you are an out-of-state
purchaser.
Seller must keep this certifi cate on fi le to support exempt sales.
Instructions for Completing Form AVF-105
Purchaser must:
Check a box to indicate if this is a single purchase or blanket exemption;
Check the reason for the exemption;
Sign and date the form; and
Print the name and title of the signer.
Note: The Indiana taxpayer identifi cation number (TID) is a 10-digit number followed by a 3-digit location number (LOC).
The TID is also known as the following:
Registered Retail Merchant Certifi cate
Tax Exempt Identifi cation Number
Sales Tax Identifi cation Number
Withholding Tax Identifi cation Number
The Registered Retail Merchant Certifi cate issued by the Indiana Department of Revenue shows the TID (10 digits) and
the LOC (3 digits) in the upper-right corner of the certifi cate.
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