New York State Department of Taxation and Finance
                                                                                                                                FT-1004 
                Certificate for Purchases of Non-Highway Diesel Motor Fuel or                                                            (6/12)
                Residual Petroleum Product for Farmers and Commercial Horse 
                Boarding Operations
To purchasers and sellers: Carefully read the information on page 2 of this form and the certifications below before giving or accepting this 
certificate.
To sellers: You must collect the applicable taxes on the sale of diesel motor fuel or residual petroleum product unless the purchaser gives 
you a properly completed exemption document no later than 90 days after the delivery of the product sold. Keep the certificate for at least 
three years from the last sale covered by this certificate.
To purchasers: Complete this certificate and give it to the seller.
Please type or print
 Name of seller                                                             Name of farmer or commercial horse boarding operator

 Street address                                                             Street address

 City                               State  ZIP code                         City          State                                 ZIP code

        Single-purchase certificate — enter invoice number                                and number of gallons                             .

        Blanket certificate — will be considered part of any order given and will remain in effect until revoked by written notice  
        from the purchaser or until the Tax Department notifies you that the purchaser may not make exempt purchases. It covers only 
        the types of purchases marked below. If the conditions change for any of the boxes marked below (a, b, c, or d), complete a new 
        Form FT-1004 to cover the new types of purchases.

Part 1 — For non-highway diesel motor fuel purchases only (mark an  Xin box a or b)

a       I certify that     % of the non-highway diesel motor fuel will be consumed directly and exclusively in the production of 
        tangible personal property for sale by farming, and all of the non-highway diesel motor fuel covered by this certificate will be 
        delivered to my farm site, and will not be consumed on the public highways of this state except to reach adjacent farmlands 
        (exempt from diesel motor fuel tax, petroleum business tax, and sales tax).

b       I certify that     % of the non-highway diesel motor fuel will be used or consumed either in the production of tangible personal 
        property for sale by farming or in a commercial horse boarding operation (see definition on back), or in both, and will not be 
        consumed on the public highways of this state except to reach adjacent farmlands or adjacent lands used in a commercial horse 
        boarding operation, or both (subject to petroleum business tax at the commercial gallonage rate, but exempt from diesel motor fuel 
        tax and sales tax).

Part 2 — For residual petroleum product purchases only(mark an  Xin box c or d)

c       I certify that     % of the residual petroleum product will be used or consumed directly and exclusively in the production of 
        tangible personal property for sale by farming, and all of the residual petroleum product covered by this certificate will be delivered 
        to my farm site (exempt from petroleum business tax and sales tax).
d       I certify that     % of the residual petroleum product will be used or consumed in the production of tangible personal property 
        for sale by farming or in a commercial horse boarding operation (see definition on back), or both (exempt from sales tax, but 
        subject to petroleum business tax at the commercial gallonage rate).

Certification: I certify that the above statements are true and complete, and I make these statements with the knowledge that willfully 
issuing a false or fraudulent certificate with the intent to evade tax is a misdemeanor under New York State Tax Law sections 1812(c)(4), 
1812-f(c)(4), and 1817(m) and Penal Law section 210.45, punishable by a fine up to $10,000 for an individual or $20,000 for a corporation. 
I also understand that the Tax Department is authorized to investigate the validity of exemptions claimed or the accuracy of any 
information entered on this form.
 Type or print name of farmer, commercial horse boarding operator, or representative

 Signature of farmer, commercial horse boarding operator, or representative                                     Date
        

Page 2 of 2   FT-1004 (6/12)
                                                                Instructions
General information                                                                Note: Kerosene is exempt from petroleum business tax if it is not 
                                                                                   blended or mixed with any other product constituting diesel motor fuel, 
This form may be used by farmers and commercial horse boarding                     motor fuel, or residual petroleum product, and is not sold or used in a 
operators to purchase diesel motor fuel and residual petroleum                     motor vehicle.
product exempt from diesel motor fuel tax, petroleum business tax, 
and state and local sales taxes.                                                   Seller 
                                                                                   You must be registered as a distributor of diesel motor fuel or as a 
Definitions                                                                        retailer of non-highway diesel motor fuel only to sell non-highway 
Farming includes agriculture, floriculture, horticulture, aquaculture,             diesel motor fuel for use directly and exclusively in the production of 
and silviculture; stock, dairy, poultry, fruit, fur bearing animal, truck,         tangible personal property by farming (boxes a and b).
and tree farming; ranching; graping; operating nurseries, greenhouses, 
vineyard trellises, or other similar structures used primarily for the             To sell residual petroleum product, you must be registered as a 
raising of agricultural, horticultural, vinicultural, viticultural, floricultural, residual petroleum product business (boxes c and d).
or silvicultural commodities; operating orchards; raising, growing,                If all entries have been completed and the certificate has been signed 
and harvesting crops, livestock, and livestock products, as defined in             by the purchaser (or representative), you may accept the certificate 
subdivision 2 of section 301 of the Agriculture and Markets Law; and               in lieu of collecting tax on your sale of the fuel type described in the 
raising, growing, and harvesting woodland products, including, but not             boxes marked.
limited to, timber, logs, lumber, pulpwood, posts, and firewood.
                                                                                   The farmer or commercial horse boarding operator must give you an 
Commercial horse boarding operation means an agricultural enterprise               exemption certificate with all entries completed no later than 90 days 
of at least seven acres and boarding at least 10 horses, regardless of             after the delivery of the non-highway diesel motor fuel or residual 
ownership, that receives $10,000 or more in gross receipts annually                petroleum product. Otherwise, the sale will be considered to have been 
from fees generated either through:                                                taxable at the time the transaction took place. If, within the 90 days, 
•  the boarding of horses; or                                                      you are given an exemption certificate that is deficient (for example, 
•  the production for sale of crops, livestock, and livestock products; or         some required entries are left blank), it will be considered satisfactory 
                                                                                   if the deficiency is corrected within a reasonable period of time. If you 
•  both.                                                                           do not receive the certificate within the 90 days, you will share with the 
Under no circumstances shall this be construed to include operations               purchaser the burden of proving the sale was exempt.
whose primary on-site function is horse racing. 
                                                                                   You must keep this exemption certificate for at least three years after 
Diesel motor fuel means No. 1 diesel fuel, No. 2 diesel fuel, biodiesel,           either the due date of the last return to which it relates or the date 
kerosene, fuel oil or other middle distillate and also motor fuel suitable         when the return was filed (whichever is later). You must also maintain a 
for use in the operation of an engine of the diesel type. Diesel motor             method of associating an exempt sale made to a particular customer 
fuel does not include any product specifically designated No. 4 diesel             with the exemption certificate you have on file for that customer.
fuel.
Non-highway diesel motor fuel means any diesel motor fuel that is                   Need help?
designated for use other than on a public highway (except for the use 
of the public highway by farmers to reach adjacent lands), and is dyed                    Visit our Web site at www.tax.ny.gov
diesel motor fuel.                                                                        •  get information and manage your taxes online
Highway diesel motor fuel means any diesel motor fuel which is not                        •  check for new online services and features
non-highway diesel motor fuel.
                                                                                         Telephone assistance
Dyed diesel motor fuel means diesel motor fuel which has been 
dyed in accordance with and for the purpose of complying with                      Miscellaneous Tax Information Center:         (518) 457-5735
26 USC 4082(a).
                                                                                   To order forms and publications:              (518) 457-5431
To the farmer or commercial horse boarding 
                                                                                   Text Telephone (TTY) Hotline (for persons with
operator                                                                             hearing and speech disabilities using a TTY):  (518) 485-5082
This is the only certificate you may use to purchase, exempt 
from diesel motor fuel tax, petroleum business tax, or sales tax,                        Persons with disabilities: In compliance with the 
non-highway diesel motor fuel or residual petroleum product for use in                    Americans with Disabilities Act, we will ensure that our 
the production of tangible personal property for sale by farming or for                   lobbies, offices, meeting rooms, and other facilities are
use in a commercial horse boarding operation, or both.                             accessible to persons with disabilities. If you have questions 
If you are a commercial fisherman, you may not use this form. You                  about special accommodations for persons with disabilities, call 
must pay the tax and apply for a refund (see Form AU-631, Claim                    the information center.
for Refund/Reimbursement of Taxes Paid on Fuel Used in a Vessel 
Engaged in Commercial Fishing).
Boxes a and c — The exemption for farmers from petroleum business 
tax imposed on purchases of non-highway diesel motor fuel, or from 
petroleum business tax imposed on purchases of residual petroleum 
product, is limited to fuel used or consumed directly and exclusively in 
the production phase of farming. Purchases for use in administration, 
storage, or marketing, or for use indirectly in farming, do not qualify. 
Boxes b and d — The exemption for farmers and commercial horse 
boarding operators from sales tax does not require the fuel to be 
used directly and exclusively in farm production or commercial 
horse boarding operations. The fuel must be used or consumed in the 
production of tangible personal property for sale by farming or in a 
commercial horse boarding operation, or both. 
For the exemption from diesel motor fuel tax, the non-highway diesel 
motor fuel must not be used on the public highways of New York 
except to reach adjacent farmlands.