Form Mf-40 - Application For Lp-Gas User - Dealer License (Page 2 of 2) in pdf

Form Mf-40 - Application For Lp-Gas User - Dealer License Page 2

INSTRUCTIONS

This application is to be completely and properly executed and must be supported by a LP-Gas User or Dealer

Bond as well as necessary Financial Statements (if requested).

1. Only the owner; one of the partners listed on the application; one of the executive officers listed, if applicant

is a corporation; or a person who has been duly authorized as attorney-in-fact by proper Power of Attorney,

which has been filed in this office, may sign the application. If applicant desires to authorize others to sign

application, forms for that purpose will be mailed upon request.

2. LP-Gas User-Dealer Bond is required for all new applicants, in the amount of $1,000 and must be executed

by a corporate surety authorized to transact business in Kansas. The bond may be signed for by the

principal owner; a partner; or if a corporation, by the president, attested by a second corporate officer.

3. There is no fee for registering additional locations. Licenses will be furnished for each location from which

LP-Gas is dispensed into motor vehicles. Please list locations in the spaces provided on the reverse side of

this form. If available spaces are not adequate, provide the required information on a supplemental sheet.

Contact the office listed below if additional locations are added at a later date.

4. There is a $5.00 fee which must accompany this license application.

This completed application or inquiries concerning this application should be directed to:

CUSTOMER RELATIONS

MOTOR FUEL TAX

KANSAS DEPARTMENT OF REVENUE

915 SW HARRISON ST

TOPEKA, KANSAS 66625-8000

PHONE: (785) 368-8222

FAX: (785) 296-4993

Form Mf-40 - Application For Lp-Gas User - Dealer License Page 2