Appendix B--Model Certificate E. Summary: This is an example of a certificate which certifies that gasoline purchased will be used to produce gasohol within 24 hours after purchase. It contains the following text:CERTIFICATE OF REGISTERED GASOHOL BLENDER. (To support sales of gasoline at the gasohol production tax rate under section 4081(c) of the Internal Revenue Code) “Name, address, and employer identification number of seller” field “Name of buyer” field ( “Buyer”) certifies the following under penalties of perjury:Buyer is registered as a gasohol blender with registration number (text field). Buyer's registration has not been suspended or revoked by the Internal Revenue Service.The gasoline bought under this certificate will be used by Buyer to produce gasohol (as defined in section 48.4081-(6)(b) of the Manufacturers and Retailers Excise Tax Regulations) within 24 hours after buying the gasoline.Type of gasohol Buyer will produce (check one only):

If the gasohol the Buyer will produce will contain ethanol, check here: (checkbox)This certificate applies to the following (complete as applicable):

Buyer will not claim a credit or refund under section 6427(f) of the Internal Revenue Code for any gasoline covered by this certificate.Buyer agrees to provide seller with a new certificate if any information in this certificate changes.Buyer understands that Buyer's registration may be revoked if the gasoline covered by this certificate is resold or is used other than in Buyer's production of the type of gasohol identified above.Buyer will reduce any alcohol mixture credit under section 40(b) by an amount equal to the benefit of the gasohol production tax rate under section 4081(c) for the gasohol to which this certificate relates.Buyer understands that the fraudulent use of this certificate may subject Buyer and all parties making any fraudulent use of this certificate to a fine or imprisonment, or both, together with the costs of prosecution.