Form 3712 - Motor Fuel Tax License Application 2009 Page 3

Download a blank fillable Form 3712 - Motor Fuel Tax License Application 2009 in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 3712 - Motor Fuel Tax License Application 2009 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Form 3712, Page 3

PART 5: REFINER INFORMATION

Biofuels

Yes

29a. Will you produce fuel-grade ethanol or biodiesel?

Yes

29b. Will you disburse fuel-grade ethanol or biodiesel from a rack?

30a. Will you produce another type of biofuel capable of powering a motor vehicle?

Yes

30b. Will you disburse that fuel from a rack?

If yes, please attach statement explaining.

31. Provide address of production facility, fuel type and annual capacity.

Address

Fuel Type

Annual Capacity

Petroleum

Yes

32. Will you refine any petroleum products?

If yes, list address for each refinery (Attach additional sheets if necessary)

Street Address

City

State

IRS Terminal Control Number

33. Total gallons of product refined. Attach additional sheets if necessary.

Estimated monthly gallons of petroleum products

Estimated monthly gallons removed across the rack from

Product

refined at your Michigan refinery(ies)

refinery(ies) in Michigan

34. Are there terminals within 5 miles of your facility?

Yes

If yes, list each address (Attach additional sheets if necessary)

Street Address

City

State

IRS Terminal Control Number

PART 6: TERMINAL OPERATOR INFORMATION

Attach copies of Terminal Lease Agreements/Throughput Agreements. See instructions for acceptable criteria for agreements.

35. Will you own/operate terminals in the state of Michigan?

Yes

If yes, how many? ________________

36. Will you own/operate a terminal(s) in another state or country from which fuel will be delivered into Michigan?

Yes

37. Will Michigan destined fuel from terminals outside of Michigan be treated the same as fuel withdrawn from Michigan terminals?

Yes

38. Identify all terminals in Michigan, and all terminals in another state or country from which fuel will be delivered into Michigan. (Attach additional

sheets if necessary).

Out of state Terminals: Method of

Name & Terminal Control Number

Address

Storage Capacity

delivery into Michigan

39. Identify position holders, by terminal, who own product in the terminals listed above. Terminal outside of Michigan need only identify position holders that

disburse with a Michigan destination (Attach additional sheets if necessary).

Position Holder Name

FEIN

Terminal Control Number or Terminal Name and Address