Form Ap-154 - Texas Application For Petroleum Product Delivery Fee Permit Form - 2010 Page 2
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4AP-154-2
Texas Application for
PRINT FORM
CLEAR FORM
(Rev.8-11/10)
Petroleum Product Delivery Fee Permit
Page 1.
• Please read instructions.
• Type or print.
• Write only in white areas.
For Comptroller's use only
JOB NAME
1. Legal name of owner (sole owner, partnership, corporation or other name)
MISCAPP
•
Master on file
2. Mailing address (street and number, P.O. Box or rural route and box number)
00991
•
Tax type/reason
City
State
ZIP code
County
6420
•
•
•
•
Reference number
Area code
Number
(
)
•
3. Enter the daytime phone number of the owner
Master account set-up
•
01100
1
4. Enter your Federal Employer Identification (FEI) Number, if any
Master mailing
2
5. Enter your Social Security Number if you are a sole owner
address change
3
Check here if you do not have either number
6.
01180
•
7. Enter your taxpayer number for reporting any Texas tax OR your Texas
County code
Vendor Identification Number if you now have or have ever had one
•
8. Indicate how your business is owned.
1 - Sole owner
2 - Partnership
3 - Texas corporation
Ownership type
7 - Limited partnership
6 - Foreign corporation
4 - Other (explain)
•
Charter number
Charter date
0 0 0
0
•
• If your business is a Texas corporation,
enter the charter number and date
• If your business is a foreign corporation, enter home state, charter number, Texas Certificate of Authority number and date.
Master phone number
add / change
Home state
Charter number
Texas Cert. of Auth. No.
Cert. of Auth. date
•
01185
Home state
Identification number
• If your business is a limited partnership,
enter the home state and identification number
Secondary mailing
address set-up
02720
9. List all general partners or principal officers of your business. If you are a sole owner, skip Item 9.
•
Tax type
Name (first, middle initial, last)
Social Security Number
Title
•
064
•
•
County code
Home address (street and number, city, state, ZIP code)
Phone (area code and number)
•
Name (first, middle initial, last)
Social Security Number
Title
Partnership set-up
•
•
Home address (street and number, city, state, ZIP code)
Phone (area code and number)
•
01140
Name (first, middle initial, last)
Social Security Number
Title
•
•
Home address (street and number, city, state, ZIP code)
Phone (area code and number)
Name (first, middle initial, last)
Social Security Number
Title
•
•
Home address (street and number, city, state, ZIP code)
Phone (area code and number)
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