Form Ap-154 - Texas Application For Petroleum Product Delivery Fee Permit Form - 2010
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4Texas Application for Petroleum Product
Delivery Fee Permit
General Information
Who Must Submit This Application - You must submit this application if you are a sole owner, partnership, corporation or other organization who
is required to be licensed under Texas Water Code sec. 26.3574.
For Assistance - If you have any questions about this application, returns or any other fee-related matter, contact the Texas State Comptroller’s
office at (800) 252-1383 or (512) 463-4600.
General Instructions -
• Please do not separate pages.
• Write only in white areas.
• Do not use dashes when entering Social Security, Federal Employer Identification (FEI), Texas Taxpayer or Texas Vendor Identification
Numbers.
• Complete this application and mail to:
Comptroller of Public Accounts
111 E. 17th St.
Austin, TX 78774-0100
Federal Privacy Act - Disclosure of your social security number is required and authorized under law, for the purpose of tax administration and
identification of any individual affected by applicable law. 42 U.S.C. §405(c)(2)(C)(i); Tex. Govt. Code §§403.011 and 403.078. Release of
information on this form in response to a public information request will be governed by the Public Information Act, Chapter 552, Government
Code, and applicable federal law.
You have certain rights under Ch. 559, Government Code, to review, request and correct information we have on file about you. Contact us at
the address or phone number listed on this form.
Specific Instructions
Item 1 - Sole owner: Enter the first name, middle initial and last name.
Item 9 - Partnership: Enter information for all partners. If a partner is
Partnership: Enter the legal name of the partnership.
a corporation, enter the Federal Employer Identification
Corporation: Enter the legal name exactly as it is registered
(FEI) Number of the corporation.
with the Secretary of State.
Corporation or other organization: Enter the information for
Other organization: Enter the title of the organization.
the principal officers (president, vice-president, secretary).
Item 2 - Enter complete mailing address where you wish to receive mail
from the Comptroller of Public Accounts. If you wish to receive
Item 15 - Enter the actual location of your business, street address or
mail at a different address for other taxes, attach a letter with
meaningful directions. Example: "3 miles south of FM 1960
other addresses.
on Jones Road." Do NOT use P.O. Box or rural route
number.
Item 4 - Enter the Federal Employer Identification (FEI) Number
assigned to your business by the Internal Revenue Service.
Item 25 - If the surety company has both a Texas Taxpayer Number
Item 7 - If you have both a Texas Taxpayer Number and a Vendor
and a Vendor Identification Number, enter only the first
Identification Number, enter the Vendor Identification Number.
eleven digits of the Vendor Identification Number.
Use only the first eleven digits of this number.
Item 8 - Other organization: Explain the type of organization.
Item 29 - Bonds must be written in accordance with the applicable
Examples: Social Club, Independent School District, Family
provisions of the Comptroller's rules.
Trust.
Texas corporation: Enter the charter number assigned by the
For additional information on bonding, contact the
Secretary of State and date of charter.
Comptroller's office.
Foreign corporation (chartered out of Texas): Enter the state in
which the business is incorporated, the charter number AND
the Texas Certificate of Authority Number and date.
Item 30 - Bond must be dated and signed by an authorized represen-
Limited partnership: Enter the state in which the partnership is
tative of the surety company and the fee payer. A written
registered and the identification number.
power of attorney must be attached to the bond.
AP-154-1 (Rev.8-11/10)
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