Form Tmt-1.2 - Renewal Application For Highway Use Tax And/or Automotive Fuel Carrier Premits 19th Series Page 3
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4HUT/AFC Permit Renewal Application - 19th Series
Continued from Form TMT-1.2
Taxpayer ID number:
Name:
10. Our records show that 18th series permits were issued for the vehicles listed below. If you do not need a 19th series permit for one or more of the vehicles listed, mark an X in the corresponding
Do not renew box below. Please leave the old permit information visible (see instructions enclosed).
Owned
Owner
Unloaded
Do not
18th series
Gross
or
equipment
HUT/AFC
Type of
weight of
weight of
renew
Manufacturer's
Type of
Make of
leased
number
(mark an X)
permit number
serial number
vehicle
fuel
vehicle
Year
vehicle
vehicle
TMT-1.2-C
For office use only
Page
of
(10/05)
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