Model Certificate C. Summary: This is an example of a certificate used to notify a person of the registration status of a registrant. The text
contains:NOTIFICATION CERTIFICATE OF TAXABLE FUEL REGISTRANT.
“Name, address, and employer identification of person receiving certificate” fieldThe undersigned taxable registrant (
“Registrant”) hereby certifies under penalties of perjury that Registrant is registered by the Internal Revenue Service with
registration number (text field) and that Registrant's registration has not been revoked or suspended by the Internal Revenue
Service.Registrant understands that the fraudulent use of this certificate may subject Registrant and all parties making such
fraudulent use of this
certificate to a fine or imprisonment, or both, together with the costs of prosecution.
“Signature and date signed” field
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“Printed or typed name of person signing” field
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“Title of person signing” field
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“Name of Registrant” field
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“Employer identification number” field
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“Address of Registrant” field
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