Application For Motor Fuel Tax Exemption Form

APPLICATION FOR MOTOR FUEL TAX EXEMPTION

MOTOR FUEL PURCHASES BY SOUTH DAKOTA INDIAN TRIBES

PART I

IDENTIFICATION

Full name of organization_________________________________________________________________

Address_______________________________________________________________________________

City, State, Zip__________________________________________________________________________

Mailing Address (if different from above)____________________________________________________

Mailing City, State, Zip (if different from above)_______________________________________________

Date activities commenced in South Dakota___________________________________________________

Date organization formed_________________________________________________________________

PART III

ACTIVITIES AND OPERATIONAL INFORMATION

Is this a non-profit organization_____________________________________________________________

Is this organization incorporated pursuant to the laws of South Dakota______________________________

Is your Board of Directors or Trustees composed exclusively of members of a recognized Indian

tribe__________________________________________________________________________________

Is the school located within Indian Country___________________________________________________

If yes, are the premises held in trust by the United States for the benefit of the tribe____________________

Is funding provided by the Indian Self-Determination and Educational Assistance Act or any other public

funding______________ If yes, indicate what funding you receive________________________________

Was this organization founded by the tribe____________________________________________________

Is the operation of the school being governed by the extensive federal regulations or supervised by the

Bureau of Indian Affairs______________ If yes, please specify the regulations and agency

______________________________________________________________________________________

Are there classes designed for Indian students which are not available in the public school system________

If yes, please list them____________________________________________________________________

Does this organization purchase motor fuel in bulk, which is then stored in fuel tanks__________________

Are the fuel tanks where the fuel is being stored located on the school premises______________________

What vehicles is the motor fuel being consumed in_____________________________________________

For what purpose are the vehicles being used__________________________________________________

Are any of the vehicles in which the motor fuel is consumed owned and licensed by the federal

government_____________ if yes, please identify those vehicles and the license number

______________________________________________________________________________________

MF-EX01 – 10/99

Application For Motor Fuel Tax Exemption Form - 1999