Indiana Commercial Natural Gas Vehicle Credit Form

Commercial Natural Gas Vehicle Credit Form
Form NGV-C
Form
NGV-C

State Form 52829
(R / 1-14)

Indiana Department of Revenue

Commercial Natural Gas Vehicle Credit Form

Please complete a form for each natural gas vehicle that qualifies for the purchase credit per IC 6-3.1-34.6.
Fax this completed form to (317) 615-2691 or email it to [email protected] within 24 hours of placing the natural gas vehicle in service to
ensure timely processing.
Contact the department at (317) 615-2630 for more information regarding this credit.

Section 1: Natural Gas Vehicle Information
Year

Make

Model

VIN

Gross Vehicle Weight*

Engine
(CNG or LNG)

Date Placed in Service**

Purchase Price***

*To qualify, the vehicle must have a gross vehicle weight greater than 33,000 pounds.
**Please enclose a copy of the bill of sale document for reference.
***Not including taxation, registration, or delivery fees.

Section 2: Registered Owner Information
Name
FEIN/SSN

Indiana Taxpayer Identification Number (TID)

Address

USDOT

City

Contact Name

State
Telephone Number

ZIP Code

Email Address

I do hereby certify under penalty of perjury that the foregoing and enclosed information is true and correct to the best of my knowledge
and is a complete and full representation based upon the best information available.
Signature:______________________________________ Date: ___________________________

Departmental Use Only
Tax Year

Credit Number

Entity Limit Met for Tax Year

Comparable Vehicle
Documentation Enclosed?

Comparable Vehicle Purchase
Price

Difference Between Natural
Gas Purchase Price and
Comparable Vehicle Purchase
Price

50% of Sum of Difference of
Purchase Prices

Credit Lessor of $15,000 or
50% Sum of Difference

Please submit with this form a copy of a purchase price estimate for a comparable diesel- or gasoline-powered qualified vehicle.
Failure to do so will result in the credit being denied.