L401-1 Fuel Charge Exemption Certificate for Registered Emitters or Users of Fuel

Download instructions for fillable PDFs

Fill out this form if you are a registered emitter or user of fuel and you want to complete a fuel charge exemption certificate.

Ways to get the form

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  Download and fill out with Acrobat Reader

  You must download and open fillable PDFs in Acrobat Reader 10 or higher.

  • Accessible Fillable PDF (l401-1-fill-23e.pdf)
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  Print and fill out by hand

  • Standard print PDF (l401-1-23e.pdf)
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  Ask for an alternate format

  You can order alternate formats such as digital audio, electronic text, braille, and large print.

  • Order alternate formats for persons with disabilities