Form Ap-170-2- Texas Application For Prepaid Fuels Tax Permit / Decal - 2005
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2AP-178-2
(Rev.12-01/5)
TEXAS APPLICATION FOR INTERNATIONAL
FUEL TAX AGREEMENT LICENSE
Page 1.
Please read instructions
• TYPE OR PRINT
• Do not write in shaded areas
1. Legal name of owner (Sole owner, partnership, corporation or other name)
For Comptroller use only
•
FEEAPP
2. Mailing address (Street & number, P.O. box or rural route and box number)
00991
5 6 2 0
•
Tax type
City
State
ZIP code
County
Reference number
•
•
•
•
3. Enter the daytime phone number of the person primarily responsible for filing tax returns ...
1
4. Enter your Federal Employer’s Identification (FEI) number, if any ..............................................
2
5. Enter your Social Security Number (SSN) if you are a sole owner ..............................................
3
6.
Check here if you do not have either FEI or SSN
7. Enter your taxpayer number for reporting any Texas tax OR your Texas
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
6 - Foreign corporation
7 - Limited partnership
4 - Other (explain) ____________________________________________
Charter number
Charter date
9. If your business is a Texas corporation,
enter the charter number and date .................................................
10. If your business is a foreign corporation, enter home state, charter number, Texas Certificate of Authority number and date.
Home state
Charter number
Texas Cert. of Auth. No.
Texas Cert. of Auth. date
Home state
Identification number
11. If your business is a limited partnership,
enter the home state and identification number ......................
12. List all general partners or principal officers of your business. (Attach additional sheets, if necessary.) If you are a sole owner, skip Item 12.
Name (First, middle initial, last)
Social Security or Federal Employer's Identification (FEI) no.
Title
•
•
Home address (Street & number, city, state, ZIP code)
Phone (Area code & number)
Name (First, middle initial, last)
Social Security or Federal Employer's Identification (FEI) no.
Title
•
•
Home address (Street & number, city, state, ZIP code)
Phone (Area code & number)
Name (First, middle initial, last)
Social Security or Federal Employer's Identification (FEI) no.
Title
•
•
Home address (Street & number, city, state, ZIP code)
Phone (Area code & number)
If you purchased an existing business or business assets, complete Items 13-16. If you did not, skip to Item 17.
13. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Trade name
Taxpayer number of former owner
14. Enter the former owner's legal name. If known, enter the former owner's address and telephone number.
Legal name of former owner
Phone (Area code & number)
Address of former owner (Street & number, city, state, ZIP code)
15. Check each of the following items you purchased.
Inventory
Corporate stock
Equipment
Real estate
Other assets
16. Enter the purchase price of the business or assets purchased and the date of purchase.
Purchase price
Date of purchase
$
17. Trade name (actual name under which your business operates)
Business number (Area code & number)
•
18. Location of your business (Use street & number or directions - NOT P.O. Box or Rural Route)
City
State
ZIP code
County
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