California Exemption Certificate from Use Tax

Exemption Certificate from Use Tax
Exemption Certificate for Qualified Sales and Purchases of Liquefied Petroleum Gas
CDTFA-230-N REV. 1 (8-17)

STATE OF CALIFORNIA

EXEMPTION CERTIFICATE FOR
QUALIFIED SALES AND PURCHASES
OF LIQUEFIED PETROLEUM GAS

CALIFORNIA DEPARTMENT OF
TAX AND FEE ADMINISTRATION

Regulation 1533
SELLER’S NAME

SELLER’S ADDRESS (street, city, state, zip code)

The undersigned purchaser hereby certifies that the LPG will be used by a qualified person, as applicable, and in the manner as
specified below (check applicable box and complete as necessary):
LPG used in a Household Activity*—In accordance with Revenue & Taxation Code section 6353(b),
% of the LPG
purchased will be delivered by the seller into a tank with a storage capacity equal to or greater than 30 gallons for use in a
household activity at the primary residence, which is not serviced by gas mains and pipes, of: 1) the purchaser; 2) a person
described in Codes 0711 to 0783 of the Standard Industrial Classification (SIC) Manual, that assists a person engaged in an
agricultural business described in Codes 0111 to 0291 of the SIC Manual ("qualified person"), or an employee of a qualified
person where the LPG is purchased by such qualified person on behalf of the person that assists a qualified person in
producing and harvesting agricultural products; or 3) a renter or tenant where the LPG is purchased by a landlord or
management company on behalf of the renter or tenant.
LPG used in an Agricultural Activity*—In accordance with Revenue & Taxation Code section 6353(b),
% of LPG
purchased will be delivered into a tank with a storage capacity equal to or greater than 30 gallons and used in producing
and harvesting agricultural products, and will be purchased by: 1) a person engaged in an agricultural business described in
Codes 0111 to 0291 of the Standard Industrial Classification (SIC) Manual ("qualified person"); or 2) a person described in
Codes 0711 to 0783 of the SIC Manual, that assists a qualified person; or 3) an employee of the qualified person.
*This certificate will be considered a blanket certificate for future purchases, unless otherwise specified. If this is a specific partial
exemption certificate, provide the purchase order or sales invoice number in the following space:

I understand that if the LPG is not used in the manner qualifying for the partial exemption, or if I am not a qualified person, as
applicable, that I am required by the Sales and Use Tax Law to report and pay the state tax measured by the sales price of the LPG to
me. I also understand that this exemption certificate is in effect as of the date shown below and will remain in effect until revoked in
writing.
PURCHASER’S NAME OR COMPANY NAME (if applicable)

DATE

SIGNATURE (signature of the purchaser, purchaser’s employee, or authorized representative of the purchaser)

PERMIT NUMBER (if applicable)1

TITLE

TELEPHONE NUMBER

ADDRESS (city, state, zip code)

1

If you are not required to hold a seller’s permit, please enter “Not Applicable.”

CLEAR

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