Form 72a300 (5-07) - Tax Registration Application For Motor Fuels License Page 4

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SECTION 10—TERMINAL OWNER-OPERATOR INFORMATION
1. Does or will applicant regularly engage in the disbursement of motor fuel from terminal facilities in Kentucky?
Yes
No (If yes, complete this section.)
2. Which type of fuel is or will be disbursed?
Gasoline
Special Fuels
3. List each storage tank used exclusively for terminal disbursement. 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.
Total
Gasoline
Special Fuels
Terminal Code Number
City
Tank Capacity
Tank Capacity
Tank Capacity
(in gallons)
(in gallons)
(in gallons)

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