Model Certificate D. Summary: This is an example of a certificate that certifies the gasoline blendstocks purchased will not be used to produce finished gasoline. The text contains:CERTIFICATE OF PERSON BUYING GASOLINE BLENDSTOCKS FOR USE OTHER THAN IN THE PRODUCTION OF FINISHED GASOLINE. (To support tax-free sales under section 4081 of the Internal Revenue Code.) “Name, address, and employer identification number of seller” fieldThe undersigned buyer ( “Buyer”) hereby certifies the following under penalties of perjury:The gasoline blendstocks to which this certificate relates will not be used to produce finished gasoline.This certificate applies to the following (complete as applicable):

Buyer will not claim a credit or refund under section 6427(h) of the Internal Revenue Code for any gasoline blendstocks covered by this certificate.Buyer will provide a new certificate to the seller if any information in this certificate changes.If Buyer resells the gasoline blendstocks to which this certificate relates, Buyer will be liable for tax unless Buyer obtains a certificate from the purchaser stating that the gasoline blendstocks will not be used to produce finished gasoline and otherwise complies with the conditions of section 48.4081-4(b)(3) of the Manufacturers and Retailers Excise Tax Regulations.Buyer understands that if Buyer violates the terms of this certificate, the Internal Revenue Service may withdraw Buyer's right to provide a certificate.Buyer has not been notified by the Internal Revenue Service that its right to provide a certificate has been withdrawn. In addition, the Internal Revenue Service has not notified Buyer that the right to provide a certificate has been withdrawn from a purchaser to which Buyer sells gasoline blendstocks tax free.Buyer understands that the fraudulent use of this certificate may subject Buyer and all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 costs of prosecution.