Cato Trail Blazers, Inc
Gas Tax Form

 I/We the undersigned do hereby clearly and unconditionally assign to Cato Trail Blazers, Inc Snowmobile Club all of our right and entitlement to the motor/diesel motor fuel tax refund being applied for on the attached refund application form FT-946/1046, Motor/Diesel Motor Fuel Tax Refund Application.

 The purpose of this assignment is to make a gift of the overpayment of tax to the Cato Trail Blazers, Inc Snowmobile Club.

The basis of the refund claim is that all of the fuel purchase by the undersigned which is the subject of the attached refund claim was used by the undersigned on snowmobile trails in New York State.

A RECEIPT MUST BE INCLUDED WITH EACH SIGNATURE.