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                            New York State Department of Taxation and Finance 
                            Manufacturing Certification for Non-Highway                                                             FT-1012
                                                                                                                                                      (6/12)
                            Diesel Motor Fuel and Residual Petroleum Product

Purchasers and sellers: Read the information on page 2 and certifications carefully before giving or accepting this certificate.
Sellers: Your sales are subject to the applicable taxes on diesel motor fuel or residual petroleum product unless the purchaser gives you a properly 
completed certification no later than 90 days after the delivery of the product sold. Keep the certificate for at least three years.
Purchasers: This form must be completed by the purchaser and given to the seller. 
Type or print
 Name of seller                                                                 Name of purchaser

 Street address                                                                 Street address

 City                                        State      ZIP code                City                                       State      ZIP code

 Seller’s Certificate of Authority number                                       Purchaser’s Certificate of Authority number

Enter specific product type:                                                  . (Use a separate Form FT-1012 for each product type.)  
 Single-purchase certificate  — enter the invoice or delivery ticket number                         and the number of gallons                   .
 Blanket certificate — will be considered part of any order given to you and will remain in force until revoked by written notice. It covers only 
 purchases of the specific product type indicated above.

 Part 1  Non-highway diesel motor fuel
          I certify that all (100%) of the non-highway diesel motor fuel covered by this certificate is being delivered on or will be brought to the 
          manufacturing site for use directly and exclusively in the production of tangible personal property for sale, by manufacturing, processing, 
          or assembly, and will not be consumed on the public highways of this state. The fuel will not be delivered to a filling station or a tank 
          equipped with a nozzle or other apparatus that can fuel a motor vehicle. (This sale is exempt from the diesel motor fuel tax, the petroleum 
          business tax, and the New York State and local sales taxes.)

 Part 2  Non-highway diesel motor fuel(If less than 100% of the fuel is to be used for manufacturing as stated above,  
                mark this box and indicate the appropriate percentages (must total 100%) of use.)

 a        I certify that            % of the fuel is to be used in the production of tangible personal property for sale as described above (must be 
          supported by an engineering study).
 b        I certify that            % of the fuel is to be used for nonresidential (commercial) heating purposes. (This sale is subject to the petroleum 
          business tax at the nonresidential heating rate for diesel motor fuel and the New York State and local sales taxes, but exempt from the 
          diesel motor fuel tax.)
 c        I certify that            % of the fuel is to be used in the production of tangible personal property for sale by refining, mining or 
          extracting. The fuel will not be delivered to a filling station or a storage tank equipped with a nozzle or other apparatus that can fuel 
          a motor vehicle or be used on the public highways of this state. (This sale is subject to the petroleum business tax at the commercial 
          gallonage rate for diesel motor fuel but is exempt from the diesel motor fuel tax and the New York State and other local sales taxes.) 

 d        I certify that            % of the fuel is to be used in the production of gas, electricity, refrigeration or steam for sale. The fuel will not 
          be delivered to a filling station or a storage tank equipped with a nozzle or other apparatus that can fuel a motor vehicle or be used on 
          the public highways of this state. I also certify that I am not a rate-regulated electric corporation using the fuel in generators to produce 
          electricity. (This sale is subject to the petroleum business tax at the commercial gallonage rate for diesel motor fuel, and, if delivered or 
          used in New York City, the city of New York local sales tax, but exempt from the diesel motor fuel tax and the New York State and other 
          local sales taxes.)
 e        I certify that            % of the fuel is to be used by a rate-regulated electric corporation using the fuel in generators to produce 
          electricity for sale. The fuel will not be delivered to a filling station or a storage tank equipped with a nozzle or other apparatus that can fuel 
          a motor vehicle or be used on the public highways of this state. (This sale is subject to the petroleum business tax at the full non-highway 
          diesel motor fuel rate, and, if delivered or used in New York City, the city of New York local sales tax, but exempt from the diesel motor fuel 
          tax and the New York State and other local sales taxes.)

 f        I certify that            % of the fuel is to be used for residential heating purposes. (This sale is exempt from the petroleum business tax, 
          the diesel motor fuel tax, and the New York State sales tax but, if applicable, subject to local sales tax.)

 Part 3 — Residual petroleum product
          I certify that all (100%) of the residual petroleum product covered by this certificate is being delivered to the manufacturing site for use 
          directly and exclusively in the production of tangible personal property for sale, bymanufacturing,processing,    or assembly, and will not 
          be consumed on the public highways of this state. (This sale is exempt from the petroleum business tax and the New York State and local 
          sales taxes.)



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Page 2 of 2   FT-1012 (6/12)
 Part 4 — Residual petroleum product (If less than 100% of the product is to be used for manufacturing as stated    
              above, check this box and indicate the appropriate percentages (must total 100%) of use.) 
 a        I certify that       % of the product is to be used in the production of tangible personal property for sale as described above (must 
          be supported by an engineering study).
 b        I certify that       % of the product is to be used for residential heating purposes. (This sale is exempt from the petroleum business 
          tax and the New York State sales tax but, if applicable, subject to local sales tax.)
 c        I certify that       % of the product is to be used for nonresidential (commercial) heating purposes. (This sale is subject to the 
          petroleum business tax at the nonresidential heating rate for residual petroleum product and to the New York State and local sales taxes.)
 d        I certify that                     % of the product is to be used for any other purposes than that stated above except if you are a rate-regulated 
          electric corporation using the product in generators to produce electricity. (This sale is subject to the petroleum business tax at the 
          commercial gallonage rate for residual petroleum product and to the New York State and local sales taxes, unless a valid exemption 
          document is completed and given to the supplier.)

Note: Kerosene is exempt from the petroleum business tax when sold by a petroleum business registered as a distributor of diesel motor fuel or a retailer 
of non-highway diesel motor fuel only and the kerosene is not mixed or blended with other products, is not sold with any other petroleum product, or 
is not sold or used to operate motor vehicles or delivered into a tank equipped with a nozzle.
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.
 Signature of purchaser or authorized representative              Title                                                            Date

                                                               Instructions
General information                                                        Dyed diesel motor fuel means diesel motor fuel which has been dyed in 
                                                                           accordance with and for the purpose of complying with the provisions 
This certificate can be used to claim exemption from the taxes (the        of 26 USC 4082(a).
petroleum business tax, diesel motor fuel tax, and sales and use tax) 
on non-highway diesel motor fuel and residual petroleum product            Residual petroleum product is the topped crude of refinery operations 
as indicated on the front. You may use it for a single purchase or for     including No. 5 fuel oil, No. 6 fuel oil, bunker C, and that special grade 
blanket purchases of one specific type of product.                         of diesel product designated No. 4 diesel fuel, that is not suitable 
                                                                           for use in the operation of a motor vehicle engine. This product is 
This certificate may not be used to purchase fuel for use in farm          sometimes used for the production of electric power, space heating, 
production; use Form FT-1004, Certificate for Purchases of                 vessel bunkering, and other industrial purposes.
Non-Highway Diesel Motor Fuel or Residual Petroleum Product for 
Farmers and Commercial Horse Boarding Operations.
                                                                            Need help?
Directly means the fuel must, during the production phase of a 
process, operate exempt production machinery or equipment, or               Visit our Web site at www.tax.ny.gov
create conditions necessary for production, or perform an actual part 
of the production process.                                                  •  get information and manage your taxes online
                                                                            •  check for new online services and features
Exclusively means that all of the fuel is used entirely (100%) in the 
production process.                                                         Telephone assistance
Production includes the production line of the plant, starting with the 
handling and storage of raw materials at the plant site and continuing     Miscellaneous Tax Information Center:           (518) 457-5735
through the last step of production where the product is finished and      To order forms and publications:                (518) 457-5431
packaged for sale.
                                                                           Text Telephone (TTY) Hotline (for persons with
Manufacturing means the production of tangible personal property that        hearing and speech disabilities using a TTY):  (518) 485-5082
has a different identity from its ingredients.
Processing means the performance of any service on tangible personal        Persons with disabilities: In compliance with the 
property that changes the nature, shape, or form of the property.           Americans with Disabilities Act, we will ensure that our 
                                                                            lobbies, offices, meeting rooms, and other facilities are
Assembly means the coupling or the uniting of parts or materials as        accessible to persons with disabilities. If you have questions 
a manufacturing process or a step in the manufacturing process that        about special accommodations for persons with disabilities, call 
results in a new product.                                                  the information center.
Diesel motor fuel means No. 1 diesel fuel, No. 2 diesel fuel, biodiesel, 
kerosene, fuel oil or other middle distillate and also motor fuel suitable 
for use in the operation of an engine of the diesel type. It does not 
include any product specifically designated No. 4 diesel fuel.
Non-highway diesel motor fuel means any diesel motor fuel that is 
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 
diesel motor fuel.
Highway diesel motor fuel means any diesel motor fuel which is not 
non-highway diesel motor fuel.






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