Form Tc-69 - Utah State Business And Tax Registration Page 6
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Print Form
8f. Estimate your monthly total taxable gallons for each fuel type you checked.
50,000 or less
50,001-150,000
150,001-300,000
300,001 or more
1. Aviation fuel
2. Environmental assurance fee
3. Motor fuel
4. Special fuel
5. Compressed Natural Gas*
6. Liquefied Natural Gas**
7. Hydrogen***
* Estimate taxable gallons in gasoline gallon equivalents (GGE = 5.66 lbs.)
** Estimate taxable gallons in diesel gallon equivalents (DGE = 6.06 lbs.)
*** Estimate taxable gallons in gasoline gallon equivalents (GGE = 2.198 lbs.)
8g. General questions
We may deny your license if you do not answer all questions that apply to you.
1. Provide the state, supplier and estimated monthly gallons of fuel imports (attach additional sheets if necessary):
_ ___ _
_ __ _ __ _ _ __ _ __
__ _ _
a. Motor fuels
State importing from:
Supplier name:
Est. gallons per month:
__ ___
__ _ __ _ __ _ __ _ _
_ __ _
b. Diesel/biodiesel fuels
State importing from:
Supplier name:
Est. gallons per month:
_ ___ _
_ __ _ __ _ _ __ _ __
__ _ _
c. Aviation fuels
State importing from:
Supplier name:
Est. gallons per month:
_ ___ _
__ _ __ _ __ _ __ _ _
_ __ _
d. Other petroleum
State importing from:
Supplier name:
Est. gallons per month:
2. How will you report motor, aviation and diesel fuel gallons?
(The basis you choose must stay the same for the calendar year. You may only change your election on January 1.)
Gross election – actual meter amount
Net election – converted to 60 degrees
Section 9 – Mining Severance
9a. When will you start operations in Utah?
Month
Day
Year
Section 10 – Oil & Gas Conservation and Severance
USTC Use
10a. When will you start operations in Utah?
Only
Month
Day
Year
OGC
OGS
10b. DOGM Number
_ ___ ___ __ __ _ _
Issued by the Utah Department of Natural Resources:
Section 11 – Radioactive Waste
11a. When will your Utah facility begin operation?
Month
Day
Year
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Parent category: Financial