Form Tmt-1.2 - Renewal Application For Highway Use Tax And/or Automotive Fuel Carrier Premits 19th Series Page 4
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1
2
3
4Taxpayer ID number:
Name:
Page
of
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).
Do not
18th series
Owned
Owner
Gross
Unloaded
renew
HUT/AFC
Manufacturer's
Type of
Type of
Make of
weight of
or
equipment
weight of
(mark an X)
permit number
serial number
vehicle
fuel
vehicle
Year
vehicle
vehicle
leased
number
HUT/AFC Permit Renewal Application - 19th Series
TMT-1.2-C
For office use only
(10/05) (back)
Continued from Form TMT-1.2-C
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