Form Mf 201 - Application For License As A Motor Fuel Dealer Form - 2010 Page 2
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3MF 201
Rev. 7/10
Page 2
11. In order to qualify for a motor fuel dealer’s license, one or more of the following qualifi cations must be met.
Place a check next to the activities that apply to your operation.
A. Any person who imports from another state or foreign country or acquires motor fuel by any means into a terminal
in this state.
B. Any person who imports motor fuel from another state or foreign country in bulk lot vehicles for subsequent sale
and distribution in this state from bulk lot vehicles.
C. Any person who refi nes motor fuel in this state.
D. Any person who acquires motor fuel from a licensed motor fuel dealer for subsequent sale and distribution by that
person in this state from bulk lot vehicles.
12. Check the type(s) of fuel you intend to sell
Gasoline
Diesel
Gasoline/alcohol blend
LPG
LNG
Heating oil
Kerosene
Biodiesel
Other (list)
13. If you intend to use fuel yourself, give approximate percentage of own use to total distribution/sale.
%
(This includes fuel used in your own vehicles and sold through your own retail service stations.)
14. Is your company owned or controlled by any other person or corporation?
Yes
No If yes, give name, address
and FEIN/SSN of the other person/corporation.
15. Do you own/rent/lease bulk storage facilities in Ohio?
Yes
No If yes, provide exact address (no P.O. box) and
gallonage capacity of each facility.
16. Do you own/rent/lease terminal storage facilities in Ohio?
Yes
No If yes, provide exact address (no P.O. box)
and gallonage capacity of each facility (attach separate sheet, if necessary).
17. Do you take a
physical inventory
book inventory of all motor fuel?
Yes
No If yes, how often?
18. Do you maintain accurate and detailed records of all motor fuel transactions, including all fuel receipts and disburse-
ments?
Yes
No If yes, how long are records kept?
19. Do you produce ethanol, bio-diesel or other types of liquid alternative fuels? If so, list which types are produced and
estimated number of gallons produced annually.
20. Do you blend alcohol/gasoline?
Yes
No
21. Do you import motor fuel into Ohio from any other state, territory or province?
Yes
No If yes, list the state(s),
etc.
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