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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)

New Certificate
Renewal Certificate

SELLER’S NAME Robert V. Jensen,INC

SELLER'S ADDRESS (street, city, state, zip code)4029 S. Maple Ave- Fresno,CA-93725

SELLER’S FEDERAL EMPLOYEE IDENTIFICATION NUMBER (FEIN) 94-2266370

SELLER’S CDTFA DIESEL FUEL TAX NUMBER 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):

On a farm (as defined in the Diesel Fuel Tax Regulation 1431(d)) and Buyer is the owner, tenant or operator of the farm on which the fuel will be used.

Type of farming (include information relating to growing or raising)

On a farm (as defined in the Diesel Fuel Tax Regulation 1431(c)) relating to cultivating, raising or harvesting and Buyer is not the owner, tenant or operator of the farm on which the fuel will be used.

Description of operation (harvesting, etc.)

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

Buyer account or order number

This is a certificate covering all purchases to be used on a farm for farming purposes.

Effective Date Expiration Date (period not to exceed one year after the effective date)

This is a single purchase certificate:

Invoice or delivery ticket number Number of gallons purchased

This is a certificate for

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

Effective Date Expiration Date (period not to exceed one year after the effective date)

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.

BUYER TYPE OF BUSINESS (check one)

Sole Owner
Married Co-ownership
Registered Domestic Partnership
Partnership
Corporation
Limited Liability Company (LLC)

Other

(please specify):

LIST PARTNERS (if partnership)

NAME OF BUYER/OWNER (print or type)

BUYER/OWNER EMPLOYER ID NUMBER

DBA

BUYER/OWNER SSN (married co-ownership, registered domestic partnership or partnerships – list SSN for each partner)

CORPORATION ID (list corporation number issued by Secretary of State)

PHYSICAL ADDRESS OF BUYER/BUSINESS (street, city, state, zip code)

MAILING ADDRESS OF BUYER/BUSINESS (if different from physical address)

BULK DELIVERY ADDRESS (if different from physical address)

TELEPHONE NUMBER OF BUYER/BUSINESS

FAX NUMBER

EMAIL ADDRESS

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.

DATE

PRINT NAME AND TITLE OF PERSON SIGNING

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

July 22, 2019 7:40 am PDT

Certificate of Farming Use Form Uploaded by RV Jensen Admin - credit@rvjensen.com IP 206.169.107.66

July 30, 2019 1:41 pm PDT

Eddie 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 PDT

Eddie 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 PDT

Credit 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 PDT