Form Mft-7r - Application For Renewal Of Wholesale Dealer'S License - 2000 Page 2
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29. List below each location, out of which you sell or use “fuel”. Under type of plant state whether Service Station (S.S.), Storage Tank (S.T.), Bulk Plant
(B.P.). If more than four locations, attach additional sheet giving same information.
Location
Type of Plant
Number of Tanks
Total Capacity of Plant (Gals.)
10. List parent company, wholly owned subsidiaries, and/or any affiliates_______________________________________________________________
_______________________________________________________________________________________________________________________
11. Give name, title and address of agent in New Jersey or registered New Jersey agent on whom service may be made (must be documented by letter
from agent)._____________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
NOTE: Item number 11 must be completed by out-of-state businesses.
12. List the names and addresses of all persons from whom applicant purchased fuels, and list products purchased.
NAME and ADDRESS
PRODUCT
_______________________________________________________________
___________________________________________________
_______________________________________________________________
___________________________________________________
_______________________________________________________________
___________________________________________________
13. Give name, title, address and telephone number of person charged with the duty of filing motor fuels tax reports and location where reports are
prepared and records kept.__________________________________________________________________________________________________
_______________________________________________________________________________________________________________________
14. Average monthly fuels sales during the preceding twelve months __________________________________________ gallons.
15. Average monthly fuels use during preceding twelve months ___________________________________________ gallons.
16. Number of diesel vehicles operated _________________________________________________
17. Name of common carriers utilized to transport fuels_____________________________________________________________________________
_______________________________________________________________________________________________________________________
18. Provide detailed description of business_______________________________________________________________________________________
_______________________________________________________________________________________________________________________
The undersigned applicant states, (under penalty of perjury), that all the information contained in this application is true and accurate in every
particular.
____________________________________________________
_________________________________________________________
Name of Applicant
Signature of Owner, Partner or Officer
_________________________________________________________
Title
Date
All information must be provided before the application can be processed.
The information submitted will assist this office in the processing of your request.
The Division of Taxation reserves the right to conduct a thorough investigation prior to renewing this license.
Return completed application and $450 fee to: MOTOR FUEL TAX, PO Box 189, Trenton, NJ 08695-0189
FOR DIVISION USE ONLY
License No. ______________________________________________
Investigation Initiated ____________________________________________
Effective Date_____________________________________________
Investigation Completed __________________________________________
Approved ________________________________________________
Recommendations: ___________________________________________________________________________________________________________
MFT-7R
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