Certificate of Farming Use Form


CDTFA-608 REV. 5 (6-19)

CERTIFICATE OF FARMING USE

STATE OF CALIFORNIA

CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION

(To support vendors claim for a credit, payment, or refund under

section 60502 of the Revenue and Taxation Code)

 
Robert V. Jensen,INC
4029 S. Maple Ave- Fresno,CA-93725
94-2266370

DV-HQ 57-100477

The undersigned buyer hereby certifies the following under penalty of perjury. Buyer will use the undyed diesel fuel to which this certificate relates, either (must check one below):

This certificate applies to the following (check applicable box and complete as necessary):




% of all purchases to be used on a farm for farming purposes.


NOTE: Buyer must provide a new certificate to the seller if any information in this certificate changes, or one year from effective date.

If Buyer uses the diesel fuel to which this certificate relates for a purpose other than stated in the certificate, Buyer will be liable for the state excise tax.California Diesel Fuel Tax is payable immediately upon use to the State of California, Board of Equalization, PO Box 942879, Sacramento, CA 94279-0030.

Buyer understands 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 cost of prosecution.

To the best of my knowledge all the information on this certificate is accurate until such notice of changes, and is signed under penalty of perjury.If signature of other than the Buyer, I certify I have the authority to bind the Buyer.

Leave this empty:

Robert V. Jensen, Inc https://rvjensen.com
Signature Certificate
Document name: Certificate of Farming Use Form
Unique Document ID: ad2aab102c0b48251aac5a4b84793b07b9b55d08
Timestamp Audit
July 22, 2019 7:40 am PDTCertificate of Farming Use Form Uploaded by RV Jensen Admin - credit@rvjensen.com IP 206.169.107.66
July 30, 2019 1:41 pm PDTEddie Montoya - emontoya@bctconsulting.com added by BCT Admin - bctdevelopers3@gmail.com as a CC'd Recipient Ip: 192.168.5.131
November 6, 2019 5:54 am PDTEddie Montoya - emontoya@bctconsulting.com added by BCT Admin - bctdevelopers3@gmail.com as a CC'd Recipient Ip: 192.168.24.67
June 23, 2020 9:54 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 206.169.107.66
June 25, 2020 2:24 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:07 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:25 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:26 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:28 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:31 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:41 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:42 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:44 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:45 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:46 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:50 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:54 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:56 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:57 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 25, 2020 3:58 am PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 202.8.125.170
June 29, 2020 2:28 pm PDTCredit Dept - credit@rvjensen.com added by RV Jensen Admin - credit@rvjensen.com as a CC'd Recipient Ip: 206.169.107.66