Form 3712 - Motor Fuel Tax License Application Page 4
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7Form 3712, Page 4
40. Will you sell gasoline to any entity that is a registrant with the Internal Revenue Service as a fuel feedstock user?
Yes
No
If you answered Yes to Line 40, provide the following information. (Attach additional sheets if necessary)
Company Name
FEIN
PART 5: REFINER INFORMATION
41. Do you have any petroleum product refining capabilities?
Yes
No
If yes, list address for each refinery (Attach additional sheets if necessary)
Street Address
City
State
IRS Terminal Control Number
42. Are there terminals within 5 miles of your facility?
Yes
No
If yes, list each address (Attach additional sheets if necessary)
Street Address
City
State
IRS Terminal Control Number
43. Total gallons of of product refined
Estimated monthly gallons of petroleum products
Estimated monthly gallons removed across the rack from
Product
refined at your Michigan refinery(ies)
refinery(ies) in Michigan
Gasoline
Gasohol
Ethanol
Methanol
Dyed Diesel
Clear Diesel
K1 Kerosene
Aviation Gasoline
Jet Fuel – Diesel
Propane
PART 6: TERMINAL OPERATOR LICENSE
Terminal Operators are mandated to electronically file monthly and annual reports.
44. Do you own/operate terminals in the State of Michigan?
Yes
No
If yes, how many? ________________
45. Do you own/operate a terminal in another state from which petroleum products are delivered into Michigan?
Yes
No
Regardless of ownership, indicate all methods of delivery into Michigan:
Pipeline
Barge/Ship
Truck
Railroad
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