N.Y. Comp. Codes R. & Regs. tit. 20, § 561.6
(c) A preliminary certification must be signed by the seller or its authorized representative. If the seller is a registered motor fuel distributor under article 12-A of the Tax Law no signature is required. The preliminary certification may be furnished by either of two methods:
(1) The seller may provide its customer with the following statement prior to delivery of motor fuel covering any and all deliveries for which a preliminary certification is authorized during a particular month: This statement must contain the names of the seller and the purchaser and the month and year covered by the statement. The statement must be renewed every month.
(Seller) certifies that both the New York State motor fuel tax and prepaid sales tax required to be paid on any fuel sold to (purchaser) have been paid or have been assumed and will be paid by the seller or were passed through to the seller by his supplier. In addition, (seller) certifies that his current authorization to issue preliminary certifications, which is herewith provided to you or has previously been provided to you, has not been revoked and is currently in effect. (Seller) also certifies that the amounts of these taxes will be stated to you within 10 business days of any delivery and in a form acceptable to the New York State Department of Taxation and Finance.
(2) Alternatively, the seller may incorporate the following statement in its bill of lading, loading ticket, delivery receipt, or other shipping document given to the purchaser at the time of delivery of the motor fuel:
(Seller) certifies that both the New York State motor fuel tax and prepaid sales tax required to be paid for the motor fuel shown on this document have been paid or have been assumed and will be paid by the seller or were passed through to the seller by his supplier. In addition, (seller) certifies that his current authorization to issue preliminary certifications, which is herewith provided to you or has previously been provided to you has not been revoked and is currently in effect. (Seller) also certifies that the amounts of these taxes will be stated to the purchaser within 10 business days of this delivery and in a form acceptable to the New York State Department of Taxation and Finance.