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2011 1040 Form

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2011 1040 Form

2011 1040 form Publication 947 - Introductory Material Table of Contents What's New Practitioners' Hotline IntroductionOrdering forms and publications. 2011 1040 form Tax questions. 2011 1040 form Useful Items - You may want to see: What's New Registered tax return preparers. 2011 1040 form  Registered tax return preparers may prepare and sign as the preparer tax returns and claims for refund and other documents for submission to the IRS. 2011 1040 form They may also represent taxpayers before revenue agents, customer service representatives, and similar IRS employees during an examination if they signed the return or claim for refund for the tax year or period under examination. 2011 1040 form Future developments. 2011 1040 form  The IRS has created a page on IRS. 2011 1040 form gov for information about Publication 947 at www. 2011 1040 form irs. 2011 1040 form gov/pub947. 2011 1040 form Information about any future developments (such as legislation enacted after we release it) will be posted on that page. 2011 1040 form Practitioners' Hotline The Practitioner Priority Service® is a nationwide, toll-free hotline that provides professional support to practitioners with account-related questions. 2011 1040 form The toll-free number for this service is 1-866-860-4259. 2011 1040 form Introduction This publication discusses who can represent a taxpayer before the IRS and what forms or documents are used to authorize a person to represent a taxpayer. 2011 1040 form Usually, attorneys, certified public accountants (CPAs), enrolled agents, enrolled retirement plan agents, and enrolled actuaries can represent taxpayers before the IRS. 2011 1040 form Under special circumstances, other individuals, including registered tax return preparers, unenrolled return preparers, and students can represent taxpayers before the IRS. 2011 1040 form For details regarding taxpayer representation, see Who Can Practice Before the IRS, later. 2011 1040 form Definitions. 2011 1040 form   Many of the terms used in this publication, such as “enrolled agent” and “practitioner” are defined in the Glossary at the back of this publication. 2011 1040 form Comments and suggestions. 2011 1040 form   We welcome your comments about this publication and your suggestions for future editions. 2011 1040 form   You can write to us at the following address: Internal Revenue Service Individual Forms and Publications Branch SE:W:CAR:MP:T:I 1111 Constitution Ave. 2011 1040 form NW, IR-6526 Washington, DC 20224   We respond to many letters by telephone. 2011 1040 form Therefore, it would be helpful if you would include your daytime phone number, including the area code, in your correspondence. 2011 1040 form   You can email us at taxforms@irs. 2011 1040 form gov . 2011 1040 form Please put “Publications Comment” on the subject line. 2011 1040 form You can also send us comments from www. 2011 1040 form irs. 2011 1040 form gov/formspubs/, select “Comment on Tax Forms and Publications” under “Information About. 2011 1040 form ” Ordering forms and publications. 2011 1040 form   Visit www. 2011 1040 form irs. 2011 1040 form gov/formspubs/ to download forms and publications, call 1-800-829-3676, or write to the address below and receive a response within 10 days after your request is received. 2011 1040 form Internal Revenue Service 1201 N. 2011 1040 form Mitsubishi Motorway Bloomington, IL 61705-6613 Tax questions. 2011 1040 form   If you have a tax question, check the information available on IRS. 2011 1040 form gov or call 1-800-829-1040. 2011 1040 form We cannot answer tax questions sent to either of the above addresses. 2011 1040 form Useful Items - You may want to see: Publications 1 Your Rights as a Taxpayer 470 Limited Practice Without Enrollment Circular No. 2011 1040 form 230 Regulations Governing Practice before the Internal Revenue Service Forms and Instructions 2848 Power of Attorney and Declaration of Representative 8821 Tax Information Authorization Prev  Up  Next   Home   More Online Publications
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Videos - American Sign Language (ASL)

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Topic

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Accessible Tax Forms (ASL)

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01:54

Additional Medicare Tax (ASL) Text 03:06
All About IRS.gov (ASL)

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Amending My Return - (ASL)

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Are You a Victim of Identity Theft? (ASL) Text 02:19
Careers at the IRS (ASL)

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Changed Your Name After Marriage or Divorce? (ASL)

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Charitable Contributions (ASL)

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Choosing a Tax Preparer (ASL) Text 02:04
Did the IRS Receive My Payment (ASL) Text 01:15
Direct Deposit (ASL)

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Do It Yourself Free Tax Preparation (ASL) Text 02:30
Do Your Taxes for Free: Sandwich Generation (ASL)

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Earned Income Tax Credit (ASL) Text 02:29
Education Tax Credits (ASL) Text 02:31
Electronic Federal Tax Payment System (ASL)

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Employer Identification Number (ASL)

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Estimated Tax Payments (ASL)

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Exempt Organizations Select Check (ASL) Text 01:24
Fair Market Value of Charitable Donations (ASL)

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File Your 1040-EZ Using Free File (ASL) Text 00:45
File Your Taxes for Free: Sandwich Generation (ASL)

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First-Time Homebuyer Credit Account Look-Up Tool (ASL)

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For Deaf Users of Relay Services (ASL)

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Free Help Preparing Your Tax Return (ASL) Text 01:54
Free IRS Tax Help (ASL) Text 01:26
Gambling Winnings and Losses (ASL) Text 02:28
Haven't Filed a Tax Return in Years? (ASL)

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Health Insurance on W-2 (ASL) Text 02:01
Help for Disaster Victims (ASL)

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Help Yourself! (ASL) Text 02:12
Home Office Deduction (ASL)

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How to Get 1040 Forms (ASL) Text 01:50
How to Use the Where's My Refund? Tool (ASL) Text 03:42
Innocent Spouse Relief (ASL)

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IRS Balance Due Inquiry (ASL) Text 01:15
IRS Efforts On Identity Theft (ASL) Text 02:13
IRS Identity Theft FAQ: First Steps for Victims (ASL) Text 02:54
IRS Identity Theft FAQ: Going After The Bad Guys (ASL) Text 01:57
IRS Information Available in Spanish (ASL)

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IRS Tax Forms and Publications (ASL)

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IRS Tax Payment Options (ASL)

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IRS Withholding Calculator (ASL) Text 02:34
Is Social Security Taxable? (ASL)

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Job Search Expenses (ASL)

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Last-Minute Tax Tips (ASL) Text 02:16
Lien Withdrawal (ASL) Text 02:16
Medical and Dental Expenses (ASL) Text 02:59
Message to Taxpayers Text 02:52
Military Tax Tips (ASL)

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Miscellaneous Income (ASL)

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Moving Expenses (ASL)

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Need More Time to File Your Taxes (ASL) Text 01:38
Online Payment Agreement (ASL)

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Owe More Taxes Than You Expected (ASL)

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Owe Taxes But Can't Pay (ASL)

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Phishing-Malware (ASL)

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Preparing for Disasters (ASL)

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Protect Yourself From Identity Theft (ASL) Text 02:59
Received a Letter from the IRS? (ASL)

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Record Keeping(ASL)

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Renting Your Vacation Home (ASL) Text 02:14
Required Withdrawals from Your IRA (ASL) Text 01:57
Savings Bonds (ASL)

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Selling Your Home (ASL)

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Simplified Home Office Deduction (ASL) Text 02:28
Small Tax-Exempts Annual Reporting Reminder (ASL)

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Split Refunds – Savings Bonds (ASL)

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Standard Versus Itemized Deductions (ASL)

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Summer Day Camp Expenses (ASL)

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Tanning Tax Fitness Center Exception (ASL)

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Tap into IRS for Accessible Tax Information (ASL)

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Tax Information About Same-Sex Marriage (ASL) Text 01:52
Tax Refund Scams (ASL)

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Tax Return Errors (ASL)

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Tax Scam (ASL)

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Taxable and Nontaxable Income (ASL)

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Taxpayer Assistance Centers (ASL)

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Top Tax Return Mistakes (ASL)

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Undelivered Refunds  (ASL)

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Understanding Taxes (ASL)

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Volunteer Income Tax Assistance Recruitment (ASL)

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W-2 Missing? (ASL)

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What If? (ASL)

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When Will I Get My Refund? (ASL) Text 02:42
Where Taxpayers With Disabilities Can Find Online Help from the IRS (ASL) Text 02:03
Your Guide to an IRS Audit (ASL)

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The 2011 1040 Form

2011 1040 form 18. 2011 1040 form   Appendix This appendix contains models of the certificates, waivers, reports, and statements discussed in Part One. 2011 1040 form Model Certificate A   STATEMENT OF SUBSEQUENT SELLER     1. 2011 1040 form                 Name, address, and employer identification number of seller in subsequent sale             2. 2011 1040 form                 Name, address, and employer identification number of the buyer in subsequent sale             3. 2011 1040 form         Date and location of subsequent sale             4. 2011 1040 form         Volume and type of taxable fuel sold               The undersigned seller (“Seller”) has received the copy of the first taxpayer's report provided with this statement in     connection with Seller's purchase of the taxable fuel described in this statement. 2011 1040 form       Under penalties of perjury, Seller declares that Seller has examined this statement, including any accompanying     schedules and statements, and, to the best of Seller's knowledge and belief, they are true, correct and complete. 2011 1040 form                   Signature and date signed                   Printed or typed name of person signing this report                   Title—   Model Certificate B   FIRST TAXPAYER'S REPORT   1. 2011 1040 form                     First Taxpayer's name, address and employer identification number     2. 2011 1040 form                     Name, address, and employer identification number of the buyer of the taxable fuel subject to tax     3. 2011 1040 form           Date and location of removal, entry, or sale       4. 2011 1040 form           Volume and type of taxable fuel removed, entered or sold     5. 2011 1040 form Check type of taxable event:         Removal from refinery         Entry into United States         Bulk transfer from terminal by unregistered position holder       Bulk transfer not received at an approved terminal       Sale within the bulk transfer/terminal system       Removal at the terminal rack         Removal or sale by the blender                   6. 2011 1040 form           Amount of federal excise tax paid on account of the removal, entry, or sale                   The undersigned taxpayer (“Taxpayer”) has not received, and will not claim, a credit with respect to, or a refund of, the tax     on the taxable fuel to which this form relates. 2011 1040 form       Under penalties of perjury, Taxpayer declares that Taxpayer has examined this statement, including any accompanying     schedules and statements, and to the best of Taxpayer's knowledge and belief, they are true, correct and complete. 2011 1040 form             Signature and date signed               Printed or typed name of person signing this report               Title     Model Certificate C   NOTIFICATION CERTIFICATE OF TAXABLE FUEL REGISTRANT                           Name, address, and employer identification number of person receiving certificate       The undersigned taxable registrant (“Registrant”) hereby certifies under penalties of perjury that Registrant is registered     by the Internal Revenue Service with registration number and that Registrant's registration has not     been revoked or suspended by the Internal Revenue Service. 2011 1040 form                 Registrant understands that the fraudulent use of this certificate may subject Registrant and all parties making such     fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form                       Signature and date signed                         Printed or typed name of person signing                         Title of person signing                         Name of Registrant                         Employer identification number                         Address of Registrant     Model Certificate D   CERTIFICATE OF PERSON BUYING GASOLINE BLENDSTOCKS FOR USE OTHER THAN IN THE PRODUCTION OF FINISHED GASOLINE     (To support tax-free sales (other than LUST) under section 4081 of the Internal Revenue Code. 2011 1040 form )                 Name, address, and employer identification number of seller       The undersigned buyer (“Buyer”) hereby certifies the following under penalties of perjury:       The gasoline blendstocks to which this certificate relates will not be used to produce finished gasoline. 2011 1040 form       This certificate applies to the following (complete as applicable):       If this is a single purchase certificate, check here and enter:     1. 2011 1040 form Invoice or delivery ticket number       2. 2011 1040 form (number of gallons) of(type of gasoline blendstocks)       If this is a certificate covering all purchases under a specified account or order number, check here and enter:     1. 2011 1040 form Effective date       2. 2011 1040 form Expiration date       (period not to exceed 1 year after the effective date)       3. 2011 1040 form Type (or types) of gasoline blendstocks     4. 2011 1040 form Buyer's account or order number         Buyer will not claim a credit or refund under section 6427(h) of the Internal Revenue Code for any gasoline blendstocks     covered by this certificate. 2011 1040 form         Buyer will provide a new certificate to the seller if any information in this certificate changes. 2011 1040 form       If Buyer resells the gasoline blendstocks to which this certificate relates, Buyer will be liable for tax unless Buyer obtains a     certificate from the purchaser stating that the gasoline blendstocks will not be used to produce finished gasoline and otherwise complies with the conditions of §48. 2011 1040 form 4081-4(b)(3) of the Manufacturers and Retailers Excise Tax Regulations. 2011 1040 form       Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's     right to provide a certificate. 2011 1040 form       Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. 2011 1040 form     In addition, the Internal Revenue Service has not notified Buyer that the right to provide a certificate has been withdrawn from a purchaser to which Buyer sells gasoline blendstocks tax free. 2011 1040 form       Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use     of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form             Signature and date signed               Printed or typed name of person signing               Title of person signing               Name of Buyer               Employer identification number               Address of Buyer     Model Certificate G   CERTIFICATE OF REGISTERED FEEDSTOCK USER     (To support tax-free removals and entries (other than LUST) of kerosene under section 4082 of the Internal Revenue Code. 2011 1040 form )         (Buyer) certifies the following under penalties of perjury:       Name of buyer         Buyer is a registered feedstock user with registration number . 2011 1040 form Buyer's registration has not been revoked     or suspended. 2011 1040 form         The kerosene to which this certificate applies will be used by Buyer for a feedstock purpose. 2011 1040 form                 This certificate applies to percent of Buyer's purchases from (name, address, and employer     identification number of seller) as follows (complete as applicable):       1. 2011 1040 form A single purchase on invoice or delivery ticket number . 2011 1040 form                 2. 2011 1040 form All purchases between (effective date) and (expiration date) (period not to exceed     one year after the effective date) under account or order number(s) . 2011 1040 form If this certificate applies only to Buyer's     purchases for certain locations, check here and list the locations. 2011 1040 form                                   If Buyer sells the kerosene to which this certificate relates, Buyer will be liable for tax on that sale. 2011 1040 form                 Buyer will provide a new certificate to the seller if any information in this certificate changes. 2011 1040 form                 If Buyer violates the terms of this certificate, the Internal Revenue Service may revoke the Buyer's registration. 2011 1040 form                 Buyer understands that 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. 2011 1040 form             Printed or typed name of person signing               Title of person signing               Employer identification number               Address of Buyer               Signature and date signed     Model Certificate J   CERTIFICATE OF PERSON BUYING COMPRESSED NATURAL GAS (CNG) FOR A NONTAXABLE USE     (To support tax-free sales of CNG under section 4041 of the Internal Revenue Code. 2011 1040 form )                                         Name, address, and employer identification number of seller                   (“Buyer”) certifies the following under penalties of perjury:     Name of buyer                     The CNG to which this certificate relates will be used in a nontaxable use. 2011 1040 form       This certificate applies to the following (complete as applicable):               If this is a single purchase certificate, check here and enter:       1. 2011 1040 form Invoice or delivery ticket number       2. 2011 1040 form (Gasoline gallon equivalents)       If this is a certificate covering all purchases under a specified account or order number, check here and enter:         1. 2011 1040 form Effective date         2. 2011 1040 form Expiration date         (period not to exceed 1 year after the effective date)         3. 2011 1040 form Buyer's account or order number       Buyer will not claim a credit or refund under section 6427 of the Internal Revenue Code for any CNG to which this certificate relates. 2011 1040 form       Buyer will provide a new certificate to the seller if any information in this certificate changes. 2011 1040 form       Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's     right to provide a certificate. 2011 1040 form       Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. 2011 1040 form     In addition, the Internal Revenue Service has not notified Buyer that the right to provide a certificate has been withdrawn     from a purchaser to which Buyer sells CNG tax free. 2011 1040 form       Buyer understands that 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. 2011 1040 form             Printed or typed name of person signing               Title of person signing             Employer identification number               Address of Buyer               Signature and date signed     Model Certificate K   CERTIFICATE OF PERSON BUYING KEROSENE FOR USE IN AVIATION FOR     COMMERCIAL AVIATION OR NONTAXABLE USE     (To support operator liability for tax on removals of kerosene for use in aviation 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 under § 4041(c) pursuant to §§4041(c) and 4082. 2011 1040 form )           Name, address, and employer identification number of position holder       The undersigned aircraft operator (“Buyer”) hereby certifies the following under the penalties of perjury:       The kerosene for use in aviation to which this certificate relates is purchased (check one): for     use on a farm for farming purposes; for use in foreign trade (reciprocal benefits required for foreign registered airlines); for use in certain helicopter and fixed-wing air ambulance uses; for use other than as a fuel in the propulsion engine of an aircraft; for the exclusive use of a qualified blood collector organization; 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). 2011 1040 form       With respect to kerosene for use in aviation purchased after June 30, 2005, for use in commercial aviation     (other than foreign trade), Buyer's registration number is. 2011 1040 form Buyer's registration has not been suspended or revoked by the Internal Revenue Service. 2011 1040 form       This certificate applies to the following (complete as applicable):     This is a single purchase certificate:       1. 2011 1040 form Invoice or delivery ticket number       2. 2011 1040 form Number of gallons     This is a certificate covering all purchases under a specified account or order number:       1. 2011 1040 form Effective date       2. 2011 1040 form Expiration date (period not to exceed 1 year after the effective date)       3. 2011 1040 form Buyer's account number       Buyer agrees to provide the person liable for tax with a new certificate if any information in this certificate changes. 2011 1040 form       If the kerosene for use in aviation 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. 2011 1040 form       If Buyer sells or uses the kerosene for use in aviation to which this certificate relates for a use other than the use     stated above, Buyer will be liable for tax. 2011 1040 form       Buyer understands that it must be prepared to establish by satisfactory evidence the purpose for which the     fuel purchased under this certificate was used. 2011 1040 form     Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. 2011 1040 form     If Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's right to provide a certificate. 2011 1040 form       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. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Waiver L 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. 2011 1040 form )               Name, Address, and Employer Identification Number of Ultimate Vendor     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. 2011 1040 form The kerosene to which this waiver relates is purchased for — (check one):       1. 2011 1040 form □ Use on a farm for farming purposes,       2. 2011 1040 form □ Use in foreign trade (reciprocal benefits required for foreign registered airlines),       3. 2011 1040 form □ Use in certain helicopter and fixed-wing air ambulance uses,       4. 2011 1040 form □ The exclusive use of a qualified blood collector organization,       5. 2011 1040 form □ The exclusive use of a nonprofit educational organization,       6. 2011 1040 form □ Use in an aircraft owned by an aircraft museum,       7. 2011 1040 form □ Use in military aircraft, or       8. 2011 1040 form □ Use in commercial aviation (other than foreign trade). 2011 1040 form     B. 2011 1040 form This waiver applies to the following (complete as applicable):       This is a single purchase waiver:           1. 2011 1040 form Invoice or delivery ticket number           2. 2011 1040 form Number of gallons       This is a waiver covering all purchases under a specified account or order number:           1. 2011 1040 form Effective date           2. 2011 1040 form Expiration date (period not to exceed 1 year after the effective date)           3. 2011 1040 form Buyer's account number       Buyer will provide a new waiver to the vendor if any information in this waiver changes. 2011 1040 form       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. 2011 1040 form       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. 2011 1040 form       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. 2011 1040 form       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. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate M   CERTIFICATE FOR STATE USE OR NONPROFIT EDUCATIONAL     ORGANIZATION USE     (To support vendor's claim for a credit or payment under § 6416(a)(4) of the Internal Revenue Code. 2011 1040 form )                       Name, address, and employer identification number of ultimate vendor       The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under the penalties of perjury:       Buyer will use the gasoline or aviation gasoline to which this certificate relates (check one):     For the exclusive use of a state or local government; or     For the exclusive use of a nonprofit educational organization. 2011 1040 form       This certificate applies to the following (complete as applicable):     This is a single purchase certificate:       1. 2011 1040 form Invoice or delivery ticket number       2. 2011 1040 form Number of gallons     This is a certificate covering all purchases under a specified account or order number:       1. 2011 1040 form Effective date       2. 2011 1040 form Expiration date (period not to exceed 1 year after the effective date)       3. 2011 1040 form Buyer's account number       Buyer will provide a new certificate to the vendor if any information in this certificate changes. 2011 1040 form       Buyer understands that by signing this certificate, Buyer gives up its right to claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. 2011 1040 form       Buyer acknowledges that it has not and will not claim any credit or payment for the gasoline or aviation gasoline to which this certificate relates. 2011 1040 form       Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Waiver N   WAIVER FOR USE BY ULTIMATE PURCHASERS OF DIESEL FUEL OR     KEROSENE USED IN INTERCITY BUS TRANSPORTATION     (To support vendor's claim for a credit or payment under § 6427 of the Internal Revenue Code. 2011 1040 form )                       Name, address, and employer identification number of ultimate vendor       The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under the penalties of perjury:       The diesel fuel or kerosene to which this waiver relates is purchased for use in intercity bus transportation. 2011 1040 form       This waiver applies to the following (complete as applicable):     This is a single purchase waiver:       1. 2011 1040 form Invoice or delivery ticket number       2. 2011 1040 form Number of gallons     This is a waiver covering all purchases under a specified account or order number:       1. 2011 1040 form Effective date       2. 2011 1040 form Expiration date (period not to exceed 1 year after the effective date)       3. 2011 1040 form Buyer's account number       Buyer will provide a new waiver to the vendor if any information in this waiver changes. 2011 1040 form       If Buyer uses the diesel fuel or kerosene to which this waiver relates for a use other than in intercity bus transportation, Buyer will be liable for tax. 2011 1040 form       Buyer understands that by signing this waiver, Buyer gives up its right to claim any credit or payment for the diesel fuel or kerosene used in intercity bus transportation. 2011 1040 form       Buyer acknowledges that it has not and will not claim any credit or payment for the diesel fuel or kerosene to which this waiver relates. 2011 1040 form       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. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate O   CERTIFICATE FOR BIODIESEL     Certificate Identification Number:     (To support a claim related to biodiesel or a biodiesel mixture under section 6426 of the Internal Revenue Code. 2011 1040 form )     The undersigned biodiesel producer (“Producer”) hereby certifies the following under penalties of perjury:   1. 2011 1040 form             Producer's name, address, and employer identification number (EIN)   2. 2011 1040 form             Name, address, and EIN of person buying the biodiesel from Producer   3. 2011 1040 form       Date and location of sale to buyer   4. 2011 1040 form This certificate applies to gallons of biodiesel. 2011 1040 form   5. 2011 1040 form Producer certifies that the biodiesel to which this certificate relates is:       % Agri-biodiesel (derived solely from virgin oils)       % Biodiesel other than agri-biodiesel       This certificate applies to the following sale:       Invoice or delivery ticket number       Total number of gallons of biodiesel sold under that invoice or delivery ticket number (including biodiesel not covered by this certificate)       Total number of certificates issued for that invoice or delivery ticket number   6. 2011 1040 form             Name, address, and employer identification number of reseller to whom certificate is issued (only in the case of certificates reissued to a reseller after the return of the original certificate)   7. 2011 1040 form Original Certificate Identification Number (only in the case of certificates reissued to a reseller after return of the original certificate). 2011 1040 form       Producer is registered as a biodiesel producer with registration number . 2011 1040 form  Producer's registration has not been suspended or revoked by the Internal Revenue Service. 2011 1040 form       Producer certifies that the biodiesel to which this certificate relates in monoalkyl esters of long chain fatty acids derived from plant or animal matter that meets the requirements of the American Society of Testing and Materials D6751 and the registration requirements for fuels and fuel additives established by EPA under section 211 of the Clean Air Act (42 U. 2011 1040 form S. 2011 1040 form C. 2011 1040 form 7545). 2011 1040 form       Producer understands that the fraudulent use of this certificate may subject Producer and all parties making any fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing this certificate           Title of person signing           Signature and date signed   Model Certificate P CERTIFICATE OF STATE USE (To support vendor's claim for credit or payment under section 6427 of the Internal Revenue Code. 2011 1040 form )               Name, Address, and Employer Identification Number of Vendor     The undersigned buyer (“Buyer”) hereby certifies the following under penalties of perjury:     A. 2011 1040 form Buyer will use the diesel fuel or kerosene to which this certificate relates for the exclusive use of a state or local government, or the District of Columbia. 2011 1040 form     B. 2011 1040 form This certificate applies to the following (complete as applicable):       1. 2011 1040 form   If this is a single purchase certificate, check here □ and enter:           a. 2011 1040 form Invoice or delivery ticket number           b. 2011 1040 form Number of gallons       2. 2011 1040 form   If this is a certificate covering all purchases under a specified account or order number, check here □  and enter:           a. 2011 1040 form Effective date           b. 2011 1040 form Expiration date   (period not to exceed 1 year after effective date)           c. 2011 1040 form Buyer's account or order number     ▪ Buyer will provide a new certificate to the vendor if any information in this certificate changes. 2011 1040 form     ▪ If Buyer uses the diesel fuel or kerosene to which this certificate relates for a purpose other than stated in the certificate, Buyer will be liable for any tax. 2011 1040 form     ▪ Buyer acknowledges that it has not and will not claim any credit or payment for the diesel fuel or kerosene to which this certificate relates. 2011 1040 form     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate Q CERTIFICATE OF ULTIMATE PURCHASER OF KEROSENE FOR USE IN NONEXEMPT, NONCOMMERCIAL AVIATION (To support vendor's claim for credit or payment under section 6427(l)(4)(C)(ii) of the Internal Revenue Code. 2011 1040 form )               Name, Address, and Employer Identification Number of Ultimate Vendor     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. 2011 1040 form The kerosene to which this certificate relates is purchased for a nonexempt use in noncommercial aviation. 2011 1040 form     B. 2011 1040 form This certificate applies to the following (complete as applicable):       1. 2011 1040 form   If this is a single purchase certificate, check here □ and enter:           a. 2011 1040 form Invoice or delivery ticket number           b. 2011 1040 form Number of gallons       2. 2011 1040 form   This is a certificate covering all purchases under a specified account or order number:           a. 2011 1040 form Effective date           b. 2011 1040 form Expiration date   (period not to exceed 1 year after effective date)           c. 2011 1040 form Buyer's account number     ▪ Buyer will provide a new certificate to the vendor if any information in this certificate changes. 2011 1040 form     ▪ If Buyer uses the kerosene to which this certificate relates for a use other than the nontaxable use stated above, Buyer will be liable for tax. 2011 1040 form     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Certificate R CERTIFICATE OF BUYER OF TAXABLE FUEL FOR USE BY A STATE OR NONPROFIT EDUCATIONAL ORGANIZATION (To support credit card issuer's claim for credit, refund, or payment under section 6416(a)(4)(B) or section 6427(l)(5)(D) of the Internal Revenue Code. 2011 1040 form )               Name, Address, and Employer Identification Number of Credit Card Issuer. 2011 1040 form     The undersigned ultimate purchaser (“Buyer”) hereby certifies the following under penalties of perjury:     A. 2011 1040 form Buyer will use the taxable fuel to which this certificate relates for the exclusive use of a state; or     B. 2011 1040 form Buyer will use the gasoline to which this certificate relates for the exclusive use of a nonprofit educational organization. 2011 1040 form     C. 2011 1040 form This certificate applies to all purchases made with the credit card identified below during the period specified:           a. 2011 1040 form Effective date of certificate           b. 2011 1040 form Expiration date of certificate   (period not to exceed 2 years after effective date)           c. 2011 1040 form Buyer's account number     ▪ Buyer will provide a new certificate to the credit card issuer if any information in this certificate changes. 2011 1040 form     ▪ Buyer understands that by signing this certificate, Buyer gives up its right to claim a credit or payment for the taxable fuel purchased with the credit card to which this certificate relates. 2011 1040 form     ▪ Buyer acknowledges that it has not and will not claim any credit or payment for the taxable fuel purchased with the credit card to which this certificate relates. 2011 1040 form     ▪ Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making such fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing           Title of person signing           Name of Buyer           Employer identification number           Address of Buyer           Signature and date signed   Model Statement S   STATEMENT OF BIODIESEL RESELLER     (To support a claim related to biodiesel or a biodiesel mixture under section 6426 of the Internal Revenue Code. 2011 1040 form )     The undersigned biodiesel producer (“Reseller”) hereby certifies the following under penalties of perjury:   1. 2011 1040 form                   Reseller's name, address, and employer identification number (EIN)   2. 2011 1040 form                   Name, address, and EIN of Reseller's buyer   3. 2011 1040 form       Date and location of sale to buyer   4. 2011 1040 form Volume of biodiesel sold   5. 2011 1040 form Certificate Identification Number on the Certificate for Biodiesel       Reseller has bought the biodiesel described in the accompanying Certificate for Biodiesel and Reseller has no reason to believe that any information in the certificate is false. 2011 1040 form       Reseller has not been notified by the Internal Revenue Service that its right to provide a certificate or statement has been withdrawn. 2011 1040 form       Reseller understands that the fraudulent use of this statement may subject Reseller and all parties making any fraudulent use of this statement to a fine or imprisonment, or both, together with the costs of prosecution. 2011 1040 form           Printed or typed name of person signing this certificate           Title of person signing           Signature and date signed   Prev  Up  Next   Home   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