Form Mvf 203 - Application For License As A Retail Motor Fuel Dealer
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MVF 203
Department of
Rev. 12/08
License number assigned
Taxation
P.O. Box 530
Columbus, OH 43216-0530
Application for License as a Retail Motor Fuel Dealer
Pursuant to Ohio Revised Code section (R.C.) 5735.02, I/we hereby apply for a motor fuel dealer’s license. For sole owner,
print individual’s name, address, owner’s SSN and FEIN of the business. For a partnership, print full name, address, and SSN
of all partners and the partnership’s FEIN. For an LLC or LLP, print the full name, address and SSN of all members. For a
corporation, print the corporate name, corporation charter number issued by the Secretary of State authorizing business in
Ohio and the corporation’s FEIN. Use a separate piece of paper if necessary.
Under penalties of prosecution, no person shall make a false
or fraudulent statement on this application.
1. Name of applicant
(If you are a corporation, DO NOT use your name, use the corporation name.)
FEIN
SSN
Ohio charter number
Telephone
Fax
E-mail
2. Trade name if other than above
Partnership
Corporation
LLC
LLP
3. Check whether applicant operates as:
Sole owner
Association
Other (list)
4. If a corporation, date of qualification
List name, address and SSN of all corporate officers and directors
5. If a corporation, state name and address of statutory agent
6. If partnership, list name, address and SSN of all partners. If LLC or LLP, list name, address and SSN of all members.
7. Location detail. List physical address of every retail location in Ohio – P.O. boxes not acceptable.
Also, list the estimated
monthly gallonage disbursement for each location listed (use a separate sheet of paper, if necessary).
8. Mailing address (if other than that shown on line 7)
9. Is your company owned or controlled by any other person or corporation?
Yes
No If yes, give name, address and
FEIN or SSN or the other person/corporation.
10. Do you maintain accurate and detailed records of all bulk motor fuel receipts?
Yes
No If yes, how long are records
kept?
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