Form Ibr-3 - Idaho Fuel Distributor License Application

Form Ibr-3 - Idaho Fuel Distributor License Application - 2010 Page 4

IBR-3

EFO00204-4

IDAHO FUEL DISTRIBUTOR LICENSE APPLICATION

06-17-2010

This application must be signed by someone who has the authority to give consent for the applicant to be

sued in Idaho courts. If the applicant is a state, local or tribal government entity, this application must be

accompanied by a separate authorization from the governing authority of the entity. That authorization

must waive sovereign immunity the entity may otherwise use against any action to enforce Idaho motor

fuels tax laws in state court. It must also describe how the person who signs the application has the

authority to bind the applicant.

This application constitutes an irrevocable submission to the jurisdiction of Idaho state courts, and

the waiver of any sovereign immunity that may otherwise be asserted, as to all disputes related to the

enforcement of Title 63, Chapter 24 of the Idaho Code.

Signature

Title

Date

Form Ibr-3 - Idaho Fuel Distributor License Application - 2010 Page 4