Form Ap-133-2 - Texas Application For Fuels Tax Permit (Page 2 of 3) in pdf

AP-133-3

TEXAS APPLICATION FOR

(Rev. 12-98/13)

FUELS TAX PERMIT

Page 2.

15. Legal name of owner (Same as Item 2)

Taxpayer number (Same as Item 8)

•

16. Trade name (actual name under which your business operates)

Business phone (Area code & no.)

17. Location of your business (Use street & number or directions - NOT P.O. Box or Rural Route)

ZIP code

County

City

State

NOT

18. Check the appropriate block for each of the following questions:

APPLICABLE

YES

Will ALL sales and purchases be tax paid?

B. Do you refine, distill, manufacture, produce or blend fuel checked in Item 1 for sale or distribution?

C. Do you regularly make deliveries of fuel checked in Item 1 into storage facilities maintained by others?

D. Do you export or import fuel checked in Item 1 other than in the fuel supply tanks of motor vehicles?

E. Do you operate motor vehicles in Texas which use the fuel checked in Item 1?

F. Are these vehicles used only in this state?

G. Do you service these vehicles from your own storage facilities in Texas?

H. Is the greater portion of fuel checked in Item 1 from your total Texas storage used on the highways?

I. Do you operate a service facility which sells liquefied gas to motor vehicles displaying out-of-state license plates,

vehicles licensed under IFTA, and/or vehicles displaying motor vehicle dealers liquefied gas tax decals?

J. Do you operate a service facility which sells fuel checked in Item 1 to aircraft?

19. Enter estimate of monthly tax

free purchases and receipts.

For Comptroller's Use Only

20. Check the specific type of permit you are applying for. (Must be the same fuel type as Item 1)

Permit set-up

•

GASOLINE (06)

NENTRY

02100

Fuel type

•

Bonded Distributor (100)

Interstate Trucker (105) (No Bond Required)

Tax paid indicator

Bonded Distributor/Interstate Trucker (110)

Gasoline Jobber (125)

•

1 - YES

2 - NO

Aviation Fuel Dealer (120)

Bond Waived

DIESEL FUEL (07)

Bonded User (205)

Aviation Fuel Dealer (120)

•

1 - YES

2 - NO

Bonded Supplier (200)

Bonded Supplier/Interstate Trucker (215)

Issue code

Interstate Trucker (210) (No Bond Required)

Diesel Fuel Jobber (225)

•

Bonded User/Interstate Trucker (220)

Permit class

LIQUEFIED GAS (08)

•

Interstate Trucker (315)

Dealer (310)

Permit year

(No Bond Required)

Dealer/Interstate Trucker (330)

•

Begin date

21. Enter your anticipated beginning effective date

•

NOTE: Surety/security information required only for bonded gasoline and diesel fuel permits.

If you answered "YES" to Item 18A, contact the Comptroller's Office at 1-800-252-1383 toll free nationwide, or call 512/463-4600.

Amount

22. Check type of surety/security securing permit applied for. (Complete only Items indicated)

Cash deposit

Amount

Letter of Credit

Certificate of Deposit assignment

(Assignment of Certificate of Deposit must be attached)

Surety bond (Complete Items 23-27)

23. Legal name of surety company/financial institution that is authorized and qualified to do business in the State of Texas

24. Mailing address of surety company/financial institution

City

State

ZIP code

County

25. Surety company/financial institution Federal Employer's Identification Number

26. Does surety company/financial institution have a Taxpayer Number for reporting

If "YES,"

any Texas tax OR a Texas Vendor Identification Number?

YES

enter no.

27. Bond beginning effective date

Bond amount

Bond/Certificate of Deposit or Letter of Credit number

Form Ap-133-2 - Texas Application For Fuels Tax Permit Page 2

Related Articles

Related forms

Related Categories