Form 660 - Motor Carrier Diesel Fuel Tax Application - 1999

ADVERTISEMENT

Michigan Department of Treasury MF - PP
This form is issued under authority of P.A. 119 of 1980, as
660 (Rev. 9-99), Formerly C-3673
amended. This law requires that each commercial motor ve-
hicle operated on Michigan highways have an annual motor
MOTOR CARRIER DIESEL FUEL TAX APPLICATION
fuel decal. Failure to comply is a misdemeanor punishable by a
fine of up to $100 or imprisonment of 90 days or both. If this
Decals are no longer available at the Treasury Field Offices. Decals
form is not completed properly, your decal may be delayed.
and licenses will be issued by the Lansing Office only.
Tax Year
ALLOW FOUR (4) WEEKS FOR DELIVERY WHEN ORDERING BY MAIL.
.
.
1.
Name, DBA, Address (City, State, ZIP)
.
2.
Account No. (FE, ME or TR)
FOR DEPARTMENT USE ONLY
3.
Ownership Type. Check one.
a. Individual
b. Husband & Wife
c. Partnership
d. Domestic Corporation
e. Foreign Corporation
f. Trust or Estate
(Attach additional pages if necessary)
Social Security
Complete Residence Address
Names of Partners, Officers or Owner
Title
Telephone No.
Number
Business Days (M-F, etc.)
Business Phone
Hours Operated (9-5, etc.)
(
)
4.
NEW APPLICANTS ONLY
What date did you start operating qualified commercial motor vehicles?
.
5.
DO YOU HAVE BULK STORAGE IN MICHIGAN?
a.
Yes
No
b. If Yes, what is the storage capacity in gallons? Gallons _________________
c. If Yes, give location. Location
.
6.
Do you sell diesel fuel to others?
Yes
No
7.
Do you only operate part of the year?
a.
Yes
No
b. If Yes, what months? ________________________
.
.
8.
Number of decal sets you will need for your "Qualified Commercial Motor Vehicles" (Please see instructions):
These decals are serialized and you are accountable for the numbers issued to your account. The decals are not transferable under penalty of law.
A SURETY BOND
is not required. However, Treasury has the option of requiring a bond upon notice to the licensee.
CERTIFICATION: I certify, under penalty of perjury, that I have read this application and that it is true and com-
plete to the best of my knowledge. The preparer's signature (if applicable) is based on all information of which
that preparer had knowledge.
I authorize Treasury to discuss my application with my preparer.
Do not discuss with my preparer.
Taxpayer's Signature
Preparer's Signature
Date
Date
Type or Print Name and Title
Business Address and Telephone Number
Mail application to: Motor Fuel Tax Division, Michigan Department of Treasury, Lansing, MI 48922.
If you have questions, contact the Motor Carrier Section at (517) 373-3183.
Deaf or hearing impaired persons should call (517) 373-9419 (TDD). FAX number (517) 241-0777

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2