Form 72a300 (5-07) - Tax Registration Application For Motor Fuels License Page 2
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4SECTION 2—IMPORT INFORMATION
1. Does or will the applicant regularly import motor fuel into Kentucky?
Yes
No (If yes, complete this section.)
2. Which type of fuel is or will be imported?
Gasoline
Special Fuels
Liquefied Petroleum Gas
3. How is the fuel transported?
Own Equipment (Attach a list of all truck vehicle identification numbers.)
For Hire Carrier (Attach a list of all transporters' names and addresses
and motor fuels transporter license numbers.)
4. List supplier(s) below and attach a copy of contract(s).
Company Name
Address
City and State Origin
5. List customer(s) below and attach a copy of contract(s).
Company Name
Address
City Destination
KY
KY
KY
SECTION 3—EXPORT INFORMATION
1. Does or will applicant regularly export motor fuel from Kentucky?
Yes
No (If yes, complete this section.)
2. Which type of fuel is or will be exported?
Gasoline
Special Fuels
3. How is the fuel transported?
Own Equipment (Attach a list of all truck vehicle identification numbers.)
For Hire Carrier (Attach a list of all transporters' names and addresses.)
4. List supplier(s) below and attach a copy of contract(s).
Company Name
Address
City Origin
KY
KY
KY
5. List customer(s) below and attach a copy of contract(s).
Company Name
Address
City and State Destination
SECTION 4—DISTRIBUTION INFORMATION
1. Does or will applicant regularly engage in the distribution of motor fuel from bulk storage facilities primarily to others in arms' length
transactions?
Yes
No (If yes, complete this section.)
2. Which type of fuel is or will be distributed?
Gasoline
Special Fuels
3. List each storage tank used exclusively for wholesale distribution. Gasoline grade includes alcohol, gasoline-alcohol blends, etc.
Special fuels type means dyed (nonhighway use) diesel, undyed (highway use) diesel and kerosene. Attach additional list if necessary.
If tanks and real estate are leased by applicant, attach name and address of owner.
Tank Capacity
Gasoline Grade
Special Fuels Type
Kentucky Location
Owned by Applicant
(in gallons)
(number, street, highway, city)
(Y or N)
4. List each storage tank used exclusively for retail distribution. Gasoline grade includes alcohol, gasoline-alcohol blends, etc. Special
fuels type means dyed (nonhighway use) diesel, undyed (highway use) diesel and kerosene. Attach additional list if necessary. If
tanks and real estate are leased by applicant, attach name and address of owner.
Tank Capacity
Gasoline Grade Special Fuels Type
Kentucky Location
Owned by
Operated Under
(in gallons)
(number, street, highway, city)
Applicant (Y or N)
the Name of
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