Form R-9008 - Certification Of Payment Of Oil Spill Oontigency Fee

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R-9008 (6/05)
Certification of Payment of Oil Spill
Contingency Fee
(R.S. 30:2451-2496)
Taxpayer Services Division
P.O. Box 201
Baton Rouge, LA 70821-0201
(225) 219-7656
(225) 219-2114 (TDD)
Revenue Account Number __________________________________________________________________
This certifies that __________________________________________________________________________
Name
________________________________________________________________________________________
Address
City
State
ZIP+4
Address
is registered with the Louisiana Department of Revenue as a marine terminal operator and is assuming
responsibility for remitting the oil spill contingency fee to the Louisiana Department of Revenue on the follow-
ing transaction(s):
Date
Owner
Transporter
Number of barrels
By signing this certification, the terminal operator assumes responsibility for payment of the fee and becomes
the party whom the Louisiana Department of Revenue will look for payment. The terminal operator accepting
this certification should retain it in his records for four years.
In lieu of this certification, Form R-9010 (Certification of Continued Responsibility for Payment of Oil Spill
Contingency Fee) may be used when there will be ongoing transactions between two companies that have
mutually decided which one will pay the fee to the Louisiana Department of Revenue.
Area code and telephone number
Signature
Date

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