Department of Taxation and Finance
                                                                                                                            FT-1004 
                         Certificate for Purchases of Non-Highway Diesel Motor                                                      (11/18)
                         Fuel or Residual Petroleum Product for Farmers and 
                         Commercial Horse Boarding Operations

Purchasers and sellers: Carefullyreadtheinformationonpage2ofthisformandthecertificationsbelowbeforegivingoracceptingthis
certificate.
Sellers: Youmustcollecttheapplicabletaxesonthesaleofdieselmotorfuelorresidualpetroleumproductunlessthepurchasergivesyoua
properlycompletedexemptiondocumentnolaterthan90daysafterthedeliveryoftheproductsold.Keepthecertificateforatleastthreeyears
fromthelastsalecoveredbythiscertificate.
Purchasers: Completethiscertificateandgiveittotheseller.
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

                                                                        Employeridentificationnumber(EIN)

         Single-purchase certificate–enterinvoice                                     andnumberof                                        .

         Blanket certificate–willbeconsideredpartofanyordergivenandwillremainineffectuntilrevokedbywrittennotice
         fromthepurchaseroruntilthe     TaxDepartmentnotifiesyouthatthepurchasermaynotmakeexemptpurchases.Itcoversonly
         thetypesofpurchasesmarkedbelow.Iftheconditionschangeforanyoftheboxesmarkedbelow(a,b,c,ord),completeanew
         FormFT-1004tocoverthenewtypesofpurchases.

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

a      Icertifythat      %ofthenon-highwaydieselmotorfuelwillbeconsumed                directly and exclusivelyintheproductionoftangible 
         personalpropertyforsalebyfarming,andallofthenon-highwaydieselmotorfuelcoveredbythiscertificate         will be delivered to 
         my farm site,andwillnotbeconsumedonthepublichighwaysofthisstateexcepttoreachadjacentfarmlands(exemptfromdiesel
         motorfueltax,petroleumbusinesstax,andsalestax).

b      Icertifythat      %ofthenon-highwaydieselmotorfuelwillbeusedorconsumedeitherintheproductionoftangiblepersonal
         propertyforsalebyfarmingorinacommercialhorseboardingoperation(seedefinitiononback),orinboth,andwillnotbe
         consumedonthepublichighwaysofthisstateexcepttoreachadjacentfarmlandsoradjacentlandsusedinacommercialhorse
         boardingoperation,orboth(subjecttopetroleumbusinesstaxatthecommercialgallonagerate,butexemptfromdieselmotorfuel
         taxandsalestax).

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

c      Icertifythat      %oftheresidualpetroleumproductwillbeusedorconsumed            directly and exclusivelyintheproductionof
         tangiblepersonalpropertyforsalebyfarming,andalloftheresidualpetroleumproductcoveredbythiscertificatewillbedeliveredto
         myfarmsite(exemptfrompetroleumbusinesstaxandsalestax).
d      Icertify       %oftheresidualpetroleumproductwillbeusedorconsumedintheproductionoftangiblepersonalproperty
         forsalebyfarmingorinacommercialhorseboardingoperation(seedefinitiononback),orboth(exemptfromsalestax,butsubject
         topetroleumbusinesstaxatthecommercialgallonagerate).

Certification:Icertifythattheabovestatementsaretrue,complete,andcorrect,andthatnomaterialinformationhasbeenomitted.I
makethesestatementswiththeknowledgethatwillfullyprovidingfalseorfraudulentinformationwiththeintenttoevadetaxmayconstitute
afelonyorothercrimeunderNew     YorkStateLaw,punishablebyasubstantialfineandpossiblejailsentence.Iunderstandthatthevendor
isrequiredtocollectsuchapplicabletaxesfrommeunlessIproperlyfurnishthiscertificatetothevendorandthatthevendormustretain
thiscertificateandmakeitavailabletothe   TaxDepartmentuponrequest.Ialsounderstandthatthe TaxDepartmentisauthorizedto
investigatethevalidityandaccuracyofanyinformationenteredonthisdocument.
Typeorprintnameoffarmer,commercialhorseboardingoperator,orrepresentative

Signatureoffarmer,commercialhorseboardingoperator,or                                                            Date
       

Page 2 of 2   FT-1004 (11/18)
                                                                  Instructions
General information                                                          Fortheexemptionfromdieselmotorfueltax,thenon-highwaydiesel
Thisformmaybeusedbyfarmersandcommercialhorseboarding                         motorfuelmustnotbeusedonthepublichighwaysofNew           Yorkexcept
operatorstopurchasedieselmotorfuelandresidualpetroleumproduct                toreachadjacentfarmlands.
exemptfromdieselmotorfueltax,petroleumbusinesstax,andstate                   Note:Keroseneisexemptfrompetroleumbusinesstaxifitisnot
andlocalsalestaxes.                                                          blendedormixedwithanyotherproductconstitutingdieselmotorfuel,
                                                                             motorfuel,orresidualpetroleumproduct,andisnotsoldorusedina
Definitions                                                                  motorvehicle.
Farming includesagriculture,floriculture,horticulture,aquaculture,and
silviculture;stock,dairy,poultry,fruit,furbearinganimal,truck,and            Seller 
treefarming;ranching;graping;operatingnurseries,greenhouses,                 Youmustberegisteredasadistributorofdieselmotorfuelorasa
vineyardtrellises,orothersimilarstructuresusedprimarilyforthe                retailerofnon-highwaydieselmotorfuelonlytosellnon-highwaydiesel
raisingofagricultural,horticultural,vinicultural,viticultural,floricultural, motorfuelforusedirectlyandexclusivelyintheproductionoftangible
orsilviculturalcommodities;operatingorchards;raising,growing,                personalpropertybyfarming(boxesaandb).
andharvestingcrops,livestock,andlivestockproducts,asdefinedin
subdivision2ofsection301ofthe   AgricultureandMarketsLaw;and                 Tosellresidualpetroleumproduct,youmustberegisteredasaresidual
raising,growing,andharvestingwoodlandproducts,including,butnot               petroleumproductbusiness(boxescandd).
limitedto,timber,logs,lumber,pulpwood,posts,andfirewood.                     Ifallentrieshavebeencompletedandthecertificatehasbeensigned
Commercial horse boarding operationmeansanagriculturalenterprise             bythepurchaser(orrepresentative),youmayacceptthecertificatein
ofatleastsevenacresandboardingatleast10horses,regardlessof                   lieuofcollectingtaxonyoursaleofthefueltypedescribedintheboxes
ownership,thatreceives$10,000ormoreingrossreceiptsannually                   marked.
fromfeesgeneratedeitherthrough:                                              Thefarmerorcommercialhorseboardingoperatormustgiveyouan
theboardingofhorses;or                                                       exemptioncertificatewithallentriescompletednolaterthan90days
theproductionforsaleofcrops,livestock,andlivestockproducts;or                afterthedeliveryofthenon-highwaydieselmotorfuelorresidual
both.                                                                        petroleumproduct.Otherwise,thesalewillbeconsideredtohavebeen
                                                                             taxableatthetimethetransactiontookplace.If,withinthe90days,
Undernocircumstancesshallthisbeconstruedtoincludeoperations                  youaregivenanexemptioncertificatethatisdeficient(forexample,
whoseprimaryon-sitefunctionishorseracing.                                    somerequiredentriesareleftblank),itwillbeconsideredsatisfactory
                                                                             ifthedeficiencyiscorrectedwithinareasonableperiodoftime.Ifyou
Diesel motor fuelmeansNo.1dieselfuel,No.2dieselfuel,biodiesel,               donotreceivethecertificatewithinthe90days,youwillsharewiththe
kerosene,fueloilorothermiddledistillateandalsomotorfuelsuitable              purchasertheburdenofprovingthesalewasexempt.
foruseintheoperationofanengineofthedieseltype.Dieselmotor
fueldoesnotincludeanyproductspecificallydesignatedNo.4diesel                 Youmustkeepthisexemptioncertificateforatleastthreeyearsafter
fuel.                                                                        eithertheduedateofthelastreturntowhichitrelatesorthedate
                                                                             whenthereturnwasfiled(whicheverislater). Youmustalsomaintain
Non-highway diesel motor fuelmeansanydieselmotorfuelthatis                   amethodofassociatinganexemptsalemadetoaparticularcustomer
designatedforuseotherthanonapublichighway(exceptfortheuse                    withtheexemptioncertificateyouhaveonfileforthatcustomer.
ofthepublichighwaybyfarmerstoreachadjacentlands),andisdyed
dieselmotorfuel.
Highway diesel motor fuelmeansanydieselmotorfuelwhichisnot                   Need help?
non-highwaydieselmotorfuel.
Dyed diesel motor fuelmeansdieselmotorfuelwhichhasbeen                                    Visitourwebsiteat www.tax.ny.gov
dyedinaccordancewithandforthepurposeofcomplyingwith                                       getinformationandmanageyourtaxesonline
26USC4082(a).                                                                             checkfornewonlineservicesandfeatures

To the farmer or commercial horse boarding                                   Telephone assistance
operator                                                                     MiscellaneousTaxInformation                 518-457-5735
Thisistheonlycertificateyoumayusetopurchase,exemptfromdiesel
motorfueltax,petroleumbusinesstax,orsalestax,non-highway                     Toorderformsand                             518-457-5431
dieselmotorfuelorresidualpetroleumproductforuseintheproduction               TextTelephone(TTY)or                        Dial7-1-1forthe      
oftangiblepersonalpropertyforsalebyfarmingorforuseina                        equipmentusers                           NewYorkRelayService
commercialhorseboardingoperation,orboth.   
If you are a commercial fisherman, you may not use this form. You 
must pay the tax and apply for a refund (seeForm AU-631,Claim 
for Refund/Reimbursement of Taxes Paid on Fuel Used in a Vessel 
Engaged in Commercial Fishing).
Boxes a and c – Theexemptionforfarmersfrompetroleumbusiness
taximposedonpurchasesofnon-highwaydieselmotorfuel,orfrom
petroleumbusinesstaximposedonpurchasesofresidualpetroleum
product,islimitedtofuelusedorconsumeddirectlyandexclusivelyin
theproductionphaseoffarming.Purchasesforuseinadministration,
storage,ormarketing,orforuseindirectlyinfarming,donotqualify.
Boxes b and d – The exemption for farmers and commercial horse 
boardingoperatorsfromsalestaxdoesnotrequirethefueltobe
useddirectly andexclusively infarmproductionorcommercial 
horseboardingoperations. Thefuelmustbeusedorconsumedinthe
productionoftangiblepersonalpropertyforsalebyfarmingorina
commercialhorseboardingoperation,orboth.