Form 3712 - Motor Fuel Tax License Application 2009 Page 6
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8Form 3712, Page 6
PART 14: LICENSE FEES
Carrier License (Pipeline, Barge, and Marine Vessel)
61. If you answered yes to item 28a or 28b, enter 0 here. There is no fee required for a carrier license.
Terminal Operator License (including Refiners)
62. If you answered yes to item(s) 29a, 29b, 30a, 30b, 32, or 35, enter $2000 here.
63. If you answered yes to item 36 or 37, enter $0 here.
Supplier
64. If you answered yes to item(s) 41, 42, 43, or 44a, enter $2000 here.
Permissive Supplier
65. If you answered yes to item 44b, enter $50 here.
Importer
66. Tankwagon Operator Importer: If you answered yes to item 48, enter $50 here.
67. Bonded Importer: If you answered yes to item 49 and selected 49a, enter $1000 here.
68. Occasional Importer: If you answered yes to item 49 and selected 49b, enter $1000 here.
Exporter
69. If you answered yes to item 50, enter $1000 here.
Blender
70. If you answered yes to item(s) 51, 52, or 53, enter $100 here.
Transporter
71. If you answered yes to item 55, enter $50 here.
Retail Diesel Waterways
72. If you answered yes to item 57, enter $50 here.
Liquefied Petroleum Gas
73. If you answered yes to item(s) 58, 59, or 60, enter $50 here.
Documents to be submitted with Motor Fuel License Application
X
X
X
X
X
X
X
X
X
X
Form 3712, Motor Fuel Tax License Application
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X
X
X
X
X
X
X
Form 3999, Trading Partner Agreement
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X
Form 4001, Supplier Electronic Filing Application
Form 4002, Terminal Operator Electronic Filing
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Application
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X
X
X
X
X
X
Form 4099, Motor Fuel Electronic Filing Application
Or Form 4041
Or Form 4041
Form 4040, Motor Fuel EFT (EFT) Credit Application
Or Form 4040
Or Form 4040
Form 4041, Motor Fuel EFT Debit Application
If
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X
X
applicable
Federal 637 Registration
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X
X
Most Current Financial Statements
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X
X
Lease Agreements/Through-Put Agreements
X
X
Copies of Licenses from other states or provinces
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Parent category: Financial