Form 3712 - Motor Fuel Tax License Application Page 3
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7Form 3712, Page 3
32. Do you sell dyed diesel fuel for taxable purposes?
If yes, explain:______________________________________________________________
Company Name
FEIN
Address
City, State, Zip
PART 4: SUPPLIER/PERMISSIVE SUPPLIER INFORMATION
Suppliers and Permissive Suppliers are mandated to electronically file monthly returns and payments.
33. Do you own fuel products stored in terminals in Michigan?
Yes
No
If yes, enter your Federal 637 Number and attach a copy._________________________________________
34. a. Do you own fuel products stored in terminals outside of Michigan from which Michigan destination state shipping papers (bills of lading or manifest)
will be issued by you, or on your behalf?
Yes
No
(If you answered "No" to both 33 and 34a, skip to Part 5.)
If yes, you must pre-collect the Michigan tax for Michigan deliveries by your customers.
b. If yes, will you remove fuel products for your own delivery to Michigan?
Yes
No
c. If yes, will you sell fuel products to customers who deliver to Michigan?
Yes
No
d. Will you import fuel grade ethanol?
Yes
No
35. Indicate the type of petroleum products in leased/owned storage facilities.
Gasoline Products
Diesel Products
Aviation Products
Misc. Products
Gasoline (065)
Ethanol (241)
Dyed Diesel (228)
Aviation Gasoline (125)
Other:_______________
Gasohol (124)
Methanol (243)
Clear Diesel (160)
Jet Fuel (130)
Transmix (122)
Other _______________
K1 Kerosene (241)
36. Complete the following for all leased terminal storage facilities (Attach additional sheets if necessary):
IRS Terminal
Delivery method to storage
From whom you lease from
City
Control Number
(Pipeline, Barge/Ship, Truck, Rail)
37. a. Do you own fuel products stored in terminals outside of the United States from which Michigan destination state shipping papers (bills of lading
or manifest) will be issued by you, or on your behalf?
Yes
No
(If no, skip to Line 39)
If yes, you must pre-collect the Michigan tax for Michigan deliveries by your customers.
b. If yes, will you remove fuel products for your own delivery to Michigan?
Yes
No
c. If yes, will you sell fuel products to customers who deliver to Michigan?
Yes
No
38. Indicate the type of petroleum products in leased/owned storage facilities outside of the United States.
Gasoline Products
Diesel Products
Aviation Products
Misc. Products
Gasoline (065)
Ethanol (241)
Dyed Diesel (228)
Aviation Gasoline (125)
Other:_______________
Gasohol (124)
Methanol (243)
Clear Diesel (160)
Jet Fuel (130)
Transmix (122)
Other _______________
K1 Kerosene (241)
Complete the following for all leased/owned terminal storage facilities outside the U.S. (Attach additional sheets if necessary):
Is the terminal licensed in
Terminal Operator/Terminal Name
Terminal Address
Will you pre-collect Michigan tax?
the State of Michigan?
39. Do you store fuel in any terminals within 5 miles of a refinery?
Yes
No
If yes, enter the terminal control number(s):__________________________________
If yes, how will you be reporting removals from these facilities?
Net
Gross
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