This document is an Environmental Assurance Fee Exemption Certificate from the Utah State Tax Commission. It certifies that the business or institution claiming exemption owns stationary storage tanks for petroleum products that are not covered by the state's environmental protection program, and that any purchases will be made directly from a refinery or importer without previous imposition of fees. The certificate must be filled out completely and kept on file by the vendor and purchaser.

1. Clear form
Utah State Tax Commission
TC-721E
Environmental Assurance Fee Exemption Certificate Rev. 6/98
Name of business or institution claiming exemption (purchaser) Telephone number
City State ZIP Code
Street address
Name of Vendor or Supplier:
I certify to the following:
1. I am the consumer and/or retailer of all petroleum products I will purchase;
2. I own or lease the stationary storage tanks where the petroleum products are stored;
3. None of these storage tanks are covered by the Department of Environmental Quality’
s
Environmental Assurance Program; and
4. This exemption certificate applies ONLY to purchases made directly from a refinery or a direct import
for which the fee has not previously been imposed.
I certify that I/we meet all the requirements above for exemption from the Environmental Assurance Fee.
Title
Authorized signature Date signed
X
Questions should be directed (preferably in writing) to Customer Service, Utah State Tax Commission,
210 N 1950 W, SLC Utah 84134, Telephone (801) 297-2200, or toll free 1-800-662-4335.
To be valid this certificate must be filled in completely, with signature and date.
DO NOT SEND THIS CERTIFICATE TO THE TAX COMMISSION
NOTE TO VENDOR -- Keep this certificate on file since it must be available for audit review.
NOTE TO PURCHASER: -- Keep a copy of this certificate for your records. You are responsible to no tify the vendor of cancellation,
modification, o r limitation of the exemption you have claimed.
If you need an a ccommodation under the Americans with Disabilities A ct, contact the Tax Commission at (801) 297-3811 or TDD (801) 297-3819. Please
allow three working days for a response.