Form Ap-133-3 - Texas Application For Fuels Tax Permit - 2015
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4AP-133-3
(Rev.12-01/15)
TEXAS APPLICATION FOR
FUELS TAX PERMIT
• TYPE OR PRINT
Page 1
• Do NOT write in shaded areas.
SOLE OWNER IDENTIFICATION
1. Name of sole owner (First, middle initial, and last name)
3 Taxpayer number for reporting any Texas tax OR Texas identification
2. Social security number (SSN)
Check here if you DO NOT
number if you now have or
2
have a SSN.
have ever had one.
NON-SOLE OWNER IDENTIFICATION
--- ALL SOLE OWNERS SKIP TO ITEM 9. ---
4. Business organization type
Texas registered limited liability partnership (PR)
Texas limited liability company (CL)
Non-Texas limited liability company (CI)
Estate (ES)
Non-Texas registered limited liability partnership (PS)
Texas profit corporation (CT)
Non-Texas profit corporation (CF)
Professional corporation (CP)
General partnership (PG)
Texas nonprofit corporation (CN)
Non-Texas nonprofit corporation (CM)
Professional association (AP)
Limited partnership (PL or PF)
Trust (FM) Please submit a copy of the trust agreement with this application
Other (explain)
5. Legal name of partnership, company, corporation, association, trust, or other
6. Taxpayer number for reporting any Texas tax OR Texas identification number if you now have or have ever had one.
1
7. Federal employer's identification number (FEIN) assigned by the Internal Revenue Service ......................................
3
8.
Check here if you do not have an FEIN. .....................................................................................................................
9. Mailing address
Street number, P.O. Box, or rural route and box number
City
State/province
ZIP code
County (or country, if outside the U.S.)
10. Name of person to contact regarding day to day business operations
Daytime phone
11. Principal type of business
Agriculture
Transportation
Retail Trade
Real Estate
Mining
Communications
Finance
Services
Construction
Utilities
Insurance
Public Administration
Manufacturing
Wholesale Trade
Other (explain)
12. Primary business activities and type of products or services to be sold
SIC
If you are a SOLE OWNER, skip to Item 18.
Charter number
Month
Day
Year
13. If the business is a Texas profit corporation, nonprofit corporation, professional
corporation, or limited liability company, enter the charter number and date. .................................
14. If the business is a non-Texas profit corporation, nonprofit corporation, professional corporation, or limited liability company, enter the state or country
of incorporation, charter number and date, Texas Certificate of Authority number and date.
State/country of inc.
Charter number
Month
Day
Year
Texas Certificate of Authority number
Month
Day
Year
If "YES," attach a
15. If the business is a corporation, have you been involved in a merger within the last seven years? ...
YES
NO
detailed explanation.
State
Number
16. If the business is a limited partnership or registered limited liability
partnership, enter the home state and registered identification number. .......................................................
17. General partners, principal members/officers, managing directors or managers
(ALL GENERAL PARTNERS MUST BE LISTED - Attach additional sheets, if necessary.)
Name
Title
Phone (Area code and number)
Home address
City
State
ZIP code
Date of Birth
SSN or FEIN
Driver’s license number
State
County (or country, if outside the U.S.)
Month
Day
Year
Percent of
ownership ______ %
Position held
Partner
Officer
Director
Corporate Stockholder
Record keeper
Name
Title
Phone (Area code and number)
Home address
City
State
ZIP code
Date of Birth
County (or country, if outside the U.S.)
SSN or FEIN
Driver’s license number
State
Month
Day
Year
Percent of
ownership ______ %
Position held
Partner
Officer
Director
Corporate Stockholder
Record keeper
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