Form Ap-154 - Texas Application For Petroleum Product Delivery Fee Permit Form - 2010 Page 3
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2
3
4AP-154-3
Texas Application for
(Rev.8-11/10)
Petroleum Product Delivery Fee Permit
•
Page 2.
• Please read instructions.
• Type or print.
• Write only in white areas.
10. Legal name of owner (same as Item 1)
Fee payer number (same as Item 7)
•
For Comptroller use only
XASTAT
If you purchased an existing business or business assets, complete Items 11 - 14. If you did not, skip to Item 15.
Effective date
m m
d
d
y
y
11. Enter the former owner's trade name. If known, enter the former owner's Texas fee payer number.
•
Trade name of former owner
Fee payer number of former owner
Permit status
•
12. Enter the former owner's legal name. If known, enter the former owner's address and telephone number.
Vendor hold
Legal name of former owner
Phone (area code and number)
W
=Wanted
•
N
=Not wanted
Address of former owner (street and number, city, state, ZIP code)
Bond waived
W
=Wanted
•
N
=Not wanted
13. Check each of the following items that you purchased.
OF
NR
Inventory
Corporate stock
Equipment
Real estate
Other assets
14. Enter the purchase price of the business or assets purchased and the date of purchase
Purchase price
Date of purchase
$
15. Trade name (actual name under which your business operates)
16. Location of your business (Use street and number or directions - NOT P.O. Box or rural route.)
City
State
ZIP code
County
Definitions:
Petroleum products - A product that is capable of being used as a fuel for the propulsion of a motor vehicle
or aircraft including motor gasoline, gasohol, other alcohol blended fuels, aviation gasoline, kerosene, distillate fuel
oil and #1 and #2 diesel. The term does not include naphtha jet fuel, kerosene-type jet fuel or a petroleum
product destined for use in chemical manufacturing or feedstock of that manufacturing.
Bulk facility - A facility, including a pipeline terminal, refinery terminal, rail and barge terminal and associated
underground and aboveground tanks, connected or separate, from which petroleum products are withdrawn from
bulk and delivered into a cargo tank or barge used to transport those products.
Withdrawal from bulk - The removal of a petroleum product from a bulk facility storage tank for delivery
directly into a cargo tank or a barge to be transported to another location, other than another bulk facility, for
distribution or sale in this state.
Cargo tanks - An assembly that is used for transporting, hauling or delivering petroleum products and that
consists of a tank having one or more compartments mounted on a wagon, truck, trailer, railcar or wheels.
17. Check the appropriate block for each of the following questions.
a. Do you operate a bulk facility?
YES
NO
b. Do you make withdrawals from bulk to be
YES
NO
delivered into a cargo tank or barge?
c. Do you import petroleum products in a
cargo tank or barge for delivery other
than into a storage tank connected to
or a part of a bulk facility in this state?
YES
NO
18. Enter your anticipated beginning effective date
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