Appendix B--Model Certificate G. Summary: This is an example of a certificate which certifies buyer is a registered feedstock user and the kerosene purchased will be used for a feedstock purpose by the buyer. It contains the following text:CERTIFICATE OF REGISTERED FEEDSTOCK USER. (To support tax-free removals and entries of kerosene under section 4082 of the Internal Revenue Code.) “Name of buyer” field (Buyer) certifies the following under penalties of perjury:Buyer is a registered feedstock user with registration number (text field). Buyer's registration has not been revoked or suspended.The kerosene to which this certificate applies will be used by Buyer for a feedstock purpose.This certificate applies to (text field) percent of Buyer's purchases from “(name, address, and employer identification number of seller)” field as follows (complete as applicable):

If Buyer sells the kerosene to which this certificate relates, Buyer will be liable for tax on that sale.Buyer will provide a new certificate to the seller if any information in this certificate changes.If Buyer violates the terms of this certificate, the Internal Revenue Service may revoke the Buyer's registration.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.